Beneficiary Claim Form

Causfy Beneficiary Protection Program

Full Name *

Email *

Country *

Are you the beneficiary named in the campaign? *

Yes No

Campaign Link *

Organizer Name (if known)

Relationship with Organizer *

None Family Friend NGO Team Other

Did you authorize the campaign? *

Yes No I don't know

Select Main Problem *

Did you contact the organizer? *

Yes No

What did you request? (evidence of use/delivery)

Attach Contact Evidence (optional)

No files selected

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

Wallet Address where funds should be received (if applicable)

I agree to perform a control test (challenge/response) with a stable token of nominal value to demonstrate control of the wallet.

Have you filed a report with local authorities? *

Yes No

I declare that I am the beneficiary (or authorized representative) and that the information is truthful. *

I agree to cooperate with the investigation and requests for information. *

I understand that Causfy may decide to refund donors instead of paying the beneficiary, as appropriate. *

I understand that the Program is discretionary and does not constitute insurance/guarantee. *

Note: By submitting the claim, we will review your case and contact you as soon as possible.