Advance Fee Fraud Reporting Form

Your web browser is currently configured to disable the use of JavaScript and VBScript. In order to complete this online web form, both JavaScript and VBScript must be enabled. To arrange an alternative method of completing this form, please contact the Queensland Police Service Computer Crime Investigation Unit at:

Phone Number:	(07) 3364 6464
Fax Number:	(07) 3236 2359
TTY:	(07) 3364 4655
E-mail Address:	cciu@police.qld.gov.au
Postal Address:	Computer Crime Investigation Unit Fraud & Corporate Crime Group State Crime Operations Command GPO Box 1440 BRISBANE QLD 4001

Alternatively, you may contact your local police station for more assistance.

PLEASE NOTE: The Computer Crime Investigation Unit can only respond to enquiries during business hours (8:30am - 4:30pm Monday to Friday AEST, excluding public holidays).

NOTE: This form is for the use of Australian Residents only.

Complete the following fields and select the Submit Report button below. Acknowledgement of the Reports receipt will be sent to the email address you nominate in the Contact Details section of this form.

Should you experience any problems with completing this form, please contact the Queensland Police Service Computer Crime Investigation Unit at:

Phone Number:	(07) 3364 6464
Fax Number:	(07) 3236 2359
TTY:	(07) 3364 4655
E-mail Address:	cciu@police.qld.gov.au
Postal Address:	Computer Crime Investigation Unit Fraud & Corporate Crime Group State Crime Operations Command GPO Box 1440 BRISBANE QLD 4001

Alternatively, you may contact your local police station for more assistance.

PLEASE NOTE: The Computer Crime Investigation Unit can only respond to enquiries during business hours (8:30am - 4:30pm Monday to Friday AEST, excluding public holidays).

* denotes mandatory field.

To which country did you first send your funds?* (This will determine the Law Enforcement Agency to which your report will be made).

Nigeria
Ghana
Any Other African Nation
Australia
Any Other Country
I did not send any funds

Reason for submitting this form*	I want to report this matter to the appropriate law enforcement agency For Information purposes ONLY
How did you realise you were a victim of a scam?*
If "Other", please give details*
Have you previously been the victim of a similar scam?*

VICTIM DETAILS

YOUR DETAILS
Surname*
Given Name(s)*
Date of Birth	Day Month Year
ADDRESS DETAILS
House/Unit Number*
Street Name*
Suburb/City*
State*
Post/Zip Code*
CONTACT DETAILS
Phone No.*	(e.g. 0733646464)
Facsimile No.	(e.g. 0733646464)
Mobile No.	(e.g. 0400000000)
E-mail Address*
Occupation*
If "Other", please give details
Gender*	Male Female

Please Select your highest level of Education*
If "Other", please give details

SCAM DETAILS

Type of scam*
If "Other", please give details*
When was the first contact you had with the offender*	Day Month Year
How was contact first made*
If "Chat Service", "Website" or "Other", please give details*
When was the last contact you had with the offender*	Day Month Year

INFORMATION ABOUT THE PERSONS YOU HAVE HAD DEALINGS WITH

INFORMATION ABOUT FINANCIAL TRANSACTIONS

Funds Sent

Have you transferred any funds overseas or locally as part of a scam?*

Date of last transaction	Day Month Year
Estimated total amount of funds sent * (Please type the estimated total amount of funds you sent during the scam. For example if you sent $15,326.23 you would type 15326.23)	$
Estimated number of times of funds sent

NOTE: You are limited to adding a maximum of five (5) financial transactions. If you have had more than 5 financial transactions regarding this scam, please provide the details in the Additional Information field below.


Financial Sent Transaction 1
Name of persons funds transferred to *
Address of persons funds transferred to
Country funds transferred to
How funds were transferred *
If "Other", please give details *
Transfer reference number (eg. If Western union, the MTCN number)
State the amount of the transaction and the reason for sending funds (eg. taxes etc) *
Further information about other transactions

Funds Received

Have you received any funds overseas or locally as part of a scam?*

Date of last transaction	Day Month Year
Estimated total amount of funds received * (Please type the estimated total amount of funds you sent during the scam. For example if you sent $15,326.23 you would type 15326.23)	$
Estimated number of times of funds received

NOTE: You are limited to adding a maximum of five (5) financial received transactions. If you have had more than 5 financial received transactions regarding this scam, please provide the details in the Additional Information field below.


Financial Received Transaction 1
Name of persons funds transferred from *
Address of persons funds transferred from
Country funds transferred from
How funds were transferred *
If "Other", please give details *
Transfer reference number (eg. If Western union, the MTCN number)
State the amount of the transaction and the reason for receiving funds (eg. taxes etc) *
Further information about other transactions

INFORMATION ABOUT PROPERTY TRANSACTIONS

Goods Received

Have you ever been requested to receive goods on behalf of the offenders*

Goods Sent

Have you ever been requested to send goods on behalf of the offenders*

INFORMATION ABOUT TRAVEL

Have you travelled locally/overseas as part of the scam to meet with those involved?*

How many times? *	1 2 3 4 5 6 or more

NOTE: You are limited to adding a maximum of five (5) travel details. If you have travelled more than 5 times regarding this scam, please provide the details in the Additional Information field below.


Trip Details 1
City and Country visited *
Date visited	Day Month Year
Name of persons met *
Specific location of meeting (eg. Hotel name etc.) *
Further information about the trips detailed above or further trips

OTHER

Please provide a chronological summary of what happened*
Have you retained copies of Emails*	Yes No
Have you retained copies of Chat Logs*	Yes No
Have you retained copies of any images received*	Yes No
Are you willing to speak to the media in relation to your experience*	Yes No

NOTE: Please be advised that you are under no obligation to speak to the media in order to have your report investigated, however from experience the Queensland Police have found this a very useful tool to alert other members of the community of the scams perpetrated by these types of offenders.

DISCLAIMER

This initiative assists victims to progress their report to Nigeria or Ghana if applicable. In each case the information provided within the online web based reporting form will simply be emailed to the appropriate investigating authority in those nations.

While the Queensland Police Service (QPS) has provided this initiative to report suspected incidents of fraudulent activity to other law enforcement agencies in some instances, the initiative is intended only as a vehicle for the convenient transfer of the information. The QPS does not have any influence or control over any subsequent investigation or actions by any law enforcement agency once the report has been transferred. The QPS does not retain ownership or responsibility for information provided to other Agencies.

This initiative is voluntary. If you are a Victim of these scams you may still report your matter directly to the applicable State or Country if you wish to do so.

Any Information supplied in the online web based reporting form may be retained by Law Enforcement for intelligence purposes.

Date or approximate date of previous scam	Day Month Year
Estimated total amount of funds sent during previous scam * (Please type the estimated total amount of funds you sent during the previous scam. For example if you sent $15,326.23 you would type 15326.23)	$
Please provide a chronological summary of what happened during the previous scam including the name of persons dealt with *

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