Donor Claim Form - Causfy Donation Protection Program

A. Claimant Identification

Full Name *

Email *

Country of Residence *

Are you the owner of the payment method / wallet used to donate? *

Yes No

B. Donation Details

Campaign Link *

Donation Date *

Donation Time *

Amount *

Currency *

Payment Method *

Card / Credit Card Cryptocurrency Bank Transfer Local Payment

If payment was made with Cryptocurrency:

Network

Hash / Transaction ID

Address from which it was sent

Card / Credit Card Details:

Last 4 digits (or partial reference)

Provider Receipt Reference

I still own the payment instrument used and I am authorized to receive a refund to the same.

Bank Transfer Details:

Bank Name *

Receipt Number *

Local Payment Details:

Provider Receipt Reference

C. Claim Reason

Select Main Reason *

Tell us what happened * Maximum 2000 characters

What statement was false and where?

Why did this lead you to donate?

What evidence demonstrates this?

D. Evidence

Upload Evidence Files

Choose Files No files selected

Up to 3 files. Max 3MB each (8MB total). JPG, PNG, WEBP, or PDF.

E. Bank Dispute / Chargeback Status

Have you initiated or plan to initiate a dispute/chargeback? *

Yes No

Dispute Date

Provider

Current Status

F. Declarations

I confirm that this claim is individual and I submit it only for my donations. * I declare that the information is truthful and that I have not provided false evidence. * I declare that I have not received a refund/compensation through another channel. * I agree to cooperate with the investigation and provide additional information if requested. * I understand that this Program is discretionary and does not constitute insurance/guarantee. * I accept the Terms and Policy of the Program. *

Note: By submitting the claim, we may notify the organizer that a refund was issued if applicable (without revealing your sensitive information).