Our goal is to educate, warn and protect our clients
about frauds which can negatively impact their lives.


Your details

1. Your name *

2. Your address *

3. Your email *

4. Your daytime telephone number *

5. Your age


Firm details

6. Name of the firm

7. Address of the firm

8. What is the telephone number of the firm that contacted you?

9. What is the website address of the firm that contacted you?

10. How were you initially contacted?

11a. Name(s) of the person(s) who contacted you?

11b. When were you first contacted?


Details of the transaction

12. What was the firm offering to do?

Which company are the shares in?

13. If not shares, which investments did they contact you about?

14a. Were you told that you would need to pay a commission or fee?

14b. What was the fee for? (legal advice, derestriction of shares, etc?)

14c. Did you invest any monies?

14d. If yes, please provide the following:
Date of purchase:

Number of shares purchased:

Purchased stock details

In which company?

Price paid for shares

Total cost of investment

14e. In what currency was the money sent?

15a. Please specify the account name/beneficiary of bank account to which the money was sent. (Not your own bank account details)

15b. Please supply the account number of bank account to which the money was sent.

15c. Please supply the sort code of bank account to which the money was sent.

15d. Please supply the IBAN of bank account to which the money was sent.

15e. Please supply the Swift Code of bank account to which the money was sent.

15f. Please note any payment reference given.

16a. Were you advised of any restrictions on the shares before purchasing?

16b. Were you told that the shares were listed or about to be listed on the stock exchange?

If yes, which exchange?

17. Have you received any documents from the company?

If yes, tick appropriate boxes.

18. Have you been contacted by any other firms offering to buy/sell shares in this manner?

If yes, we would be grateful if you could complete a separate form for each organization which has contacted you.
19. Have you reported your contact with the boiler room to any other organization including (please select all that apply)

20. Any further comments

Please, send us any documents to [email protected]

Please note that, we will answer your comments and/or questions within 24 hours, so please, check out your emails inbox or junk mail.

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