Individual Takedown Form

1
What kind of incident is it?* This field is required.Help us understand the nature of the infringement.
Phishing
Trademark infringement
Copyright infringement
Other
2
Do you have a registered Trademark or Copyright?* This field is required.
Yes
No
3
Please provide Trademark / Copyright registration number and country/location of registration* This field is required.If Trademark has not been specifically registered with a relevant authority, please provide the company registration number and registered address.
e.g. USA, registration number: 1234567
4
Please provide a link to the infringing or harmful material:* This field is required.This should be a URL to the material involved with the infringement. Very Important: Please just write a domain or URL. Do not enter text or additional information here.
e.g. https://phishfort.com/material
5
Please provide a link to the original material:* This field is required.This is a reference to material that you currently own the trademark or copyright to.
e.g. https://phishfort.com
6
Description of incident

Please provide specific details about the incident, including details about the original content (for example: services, logos, images, etc.) and its ownership. Describe how it has been stolen.
7
Please describe the incident in more detail* This field is required.Provide specific details about the original content (including logos, images, articles etc.) and its ownership. This includes any available trademark, copyright, and/or company registration details not already provided. Describe how it has been stolen.
0/0
Huge
Large
Normal
Small
Ok
Ok
8
Contact Details

Please provide us with your contact information.
9
Name* This field is required.
First Name
Last Name
10
Email* This field is required.Your work email address.
example@example.com
Email Verified
The verification code has been sent to some@email.com
Please check your mailbox and paste the code below to complete verification
••••
Didn't receive verification code?or
Receiving the email may take a few minutes, thank you for your patience!
11
Company Name
12
Contact Number (Optional)
Country Code
Area Code
Phone Number
13
Terms and Conditions* This field is required.I confirm, under the penalty of perjury, that I have a good faith belief that the use of the material in the manner specified herein is not authorized by me, the organisation I represent, its agent, or the law. I further confirm that the information provided in this form is, to the best of my knowledge, accurate. I hereby authorize PhishFort to act as my/my company's non-exclusive agent for this infringement notification process.
14
My Products
prevnext( X )
My Bag
1
My Bag
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
ORDER SUMMARY
Total costUSD
Individual Takedown3
$500.00Edit
Back
Total cost $0.00
First Name
Last Name
15
Confidentiality Statement

We at PhishFort confirm that any information submitted in this form (including all names, email addresses and phone numbers) is strictly confidential. We will not share or sell any information provided in this form with anyone not required for the purposes of the takedown. All communication regarding your takedown case is held in strict confidence.

Appointment as Agent

By submitted this form you hereby authorize PhishFort to act as your or the company's non-exclusive agent for purposes of the phishing and/or copyright and/or trademark infringement notification process. For purposes of the notification process, you hereby confirm under the penalty of perjury that the use of your or the company's content, material, copyright, and/or trademark in the manner described herein is believed in good faith to be a use not authorized by you, the company, organisation, its agent, or the law. You confirm that the information contained herein is, to the best of your knowledge, correct.

Limitation of Liability

PhishFort is not a law firm and does not purport to provide legal advice of any kind. PhishFort agrees to act as the non-exclusive agent for purposes of the takedown notification process only. Should your matter require legal assistance, PhishFort will advise you to seek the counsel of a lawyer. PhishFort shall not be held liable for any legal or other fees incurred as a result of the incident, and/or the requisite takedown notification process.
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