Complaint Form – axgard Shield

1

Terms Of Complaint
2

Claimant Information
3

Transaction Details
4

Summary of Incident
5

Submission
6

Done
7

1/7

Terms Of Complaint

Select What Describes You

I am the Claimant

I am not the Claimant

By ticking this box, you agree to provide accurate and truthful information when prompted to submit any data, including but not limited to personal details, transaction details, and details of the incident.

Non-Claimant Contact Information

First Name

Last Name

Phone

Email Address

Business Name

Country

Claimant Contact Information

First Name

Last Name

Phone

Email Address

Nationality

Address

Business Name

Country

Select Gender

Female

Male

Date Of Birth

16%

Please Specify the Transaction Details

Transaction Type

Payment Details

33%

Incident Summary Brief Summary of the Incident: Upload Supporting Files

Click to upload or drag and drop

JPG, PNG, GIF, BMP, (Max size: 50MB)

50%

Declaration and Confirmation

"Click To Agree". Claimants are expressly prohibited from intentionally submitting false, misleading, or inaccurate information. The submission of false information may lead to severe consequences, encompassing but not limited to legal action with potential civil and criminal penalties. Asgard Shield retains the right to verify the accuracy of claimant-provided information through diverse means and may necessitate claimants to furnish additional documentation for verification purposes.

I confirm that all information entered is correct.

Full Name

Your full name will be used as digital signature. Read our Privacy Policy.

66%

Your complaint is about to be submitted, click the submit button to send your complaint.

83%

Thank you for your claim submission. A recovery agent will contact you within 1-3 business days due to high demand

100%

Have you ever been a victim of Internet Fraud?

FILE A
COMPLAINT

Thank you for your claim submission.

Thank you for your claim submission. A recovery agent will contact you within 1-3 business days due to high demand

Have you ever been a victim of Internet Fraud?

FILE A COMPLAINT

Thank you for your claim submission.

Thank you for your claim submission. A recovery agent will contact you within 1-3 business days due to high demand

FILE A
COMPLAINT