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

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

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

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 (bank/organizer/third party). *

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).

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Donor Claim Form

A. Claimant Identification

B. Donation Details

If payment was made with Cryptocurrency:

Card / Credit Card Details:

Bank Transfer Details:

Local Payment Details:

C. Claim Reason

D. Evidence

E. Bank Dispute / Chargeback Status

F. Declarations

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