Fillable WU2 United States v. The Western Union Company

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WU2 United States v. The Western Union Company

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1*WU2ONE*
FOR CLAIMS
PROCESSING
ONLY
OB CB
DOC
LC
REV
RED
A
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United States v. The Western Union Company
P.O. Box 43532
Providence, RI 02940-3532
WU2
To: Victims of Western Union Fraud
Re: United States v. The Western Union Company
Court Docket Number: 1:17-cr-00011 (M.D. Pa.)
Must Be Postmarked
No Later Than
July 1, 2022
First Name M.I. Last Name
Primary Address
Primary Address Continued
City State ZIP Code
Foreign Province Foreign Postal Code Foreign Country Name/Abbreviation
Email Address (optional)
— — — —
Area Code Telephone Number (Home) Area Code Telephone Number (Work)
Petition for Remission
On January 19, 2017, the Western Union Company (Western Union) entered into a deferred prosecution agreement (DPA) with the United
States. Pursuant to the DPA, Western Union acknowledged responsibility for its criminal conduct, which included violations of the
Bank Secrecy Act and aiding and abetting wire fraud, and agreed to forfeit $586 million, which has been made available to compensate
victims of the international consumer fraud scheme through the remission process. Western Union simultaneously resolved a parallel civil
investigation with the Federal Trade Commission.
The scheme, investigated by the U.S. Postal Inspection Service, involved the targeting of consumers by fraudsters through
multiple scams. These scams included the grandparent scam, where the fraudster would pose as the victim’s relative in need of
immediate money to avoid personal harm, the lottery or sweepstakes scams, where the fraudster would tell the victim that they
had won a large cash prize but had to pay fees such as taxes to claim the prize, and the romance scams, where the fraudster would
pose as an online love interest and request funds for a visit or for another purpose. In each of these scams, the fraudsters convinced
their victims to send money through Western Union, and no victims received the promised cash, prize, or promoted item.
The U.S. Department of Justice is overseeing the remission process and hired Gilardi & Co., LLC (Gilardi) to serve as the remission
administrator in this matter. If you wired funds from a Western Union location between January 1, 2004 to January 19, 2017,
and believe you were a victim of the fraud schemes described above, please complete the information below and sign and
return this petition to the address above to be considered for compensation of your losses through the remission process. The
petition must be postmarked by July 1, 2022, You also may le a petition online at www.WesternUnionRemissionPhase2.com.
IF YOU PREVIOUSLY FILED A PETITION, NO FURTHER ACTION IS REQUIRED
2*WU2TWO*
IF YOU PREVIOUSLY FILED A PETITION, NO FURTHER ACTION IS REQUIRED
Please enter your transaction information in the section below for transfers sent between January 1, 2004 and January 19, 2017 from a
Western Union location. The 10-digit Money Transfer Control Number (MTCN) is a mandatory eld so please make sure the 10-digit
MTCN(s) is accurately entered below. If your MTCN(s) cannot be veried, you will be notied and required to submit documentation,
such as customer receipts, to support your petition. If additional space is required, please photocopy this page and attach to this petition
for remission.
Only the amount of the wire transfer will be approved for remission. Collateral expenses, such as wire transfer fees, incidental losses, or
transfers sent through other businesses, are not recoverable through the remission process.
Only transfers in your own name are eligible for remission.
Transactions
10-Digit MTCN
Sent Date (MM/DD/YYYY): Sent Amount (USD):
1.
/ /
$
.
2.
/ /
$
.
3.
/ /
$
.
4.
/ /
$
.
5.
/ /
$
.
6.
/ /
$
.
7.
/ /
$
.
8.
/ /
$
.
9.
/ /
$
.
10.
/ /
$
.
11.
/ /
$
.
12.
/ /
$
.
Failure to return this petition form or provide the required documentation will result in your exclusion from the distribution.
In addition, you have an obligation to provide Gilardi with your current contact information. Failure to maintain a valid
address with Gilardi could result in your exclusion from the distribution. Please call Gilardi at 855-786-1048 or email at
info@westernunionremissionphase2.com to update your address.
Declaration
I understand that the information I am providing in support of my petition will be used to determine my eligibility for a remission payment.
I hereby declare under penalty of perjury under the laws of the United States of America that all information on this form or included in
support of my petition is true and correct. I further certify that I have not altered any documents submitted in support of my petition.
Signature:
Dated (mm/dd/yyyy):
Print Name:
Social Security Number (this is only required for U.S. Citizens) or Individual Taxpayer Identication Number (ITIN):
— —
I am not a U.S. Citizen
Social Security Number
Must Be Postmarked No Later Than July 1, 2022
Return Petition to: United States v. The Western Union Company, P.O. Box 43532, Providence, RI 02940-3532
IF YOU PREVIOUSLY FILED A PETITION, NO FURTHER ACTION IS REQUIRED
Questions? Please call 855-786-1048, email info@westernunionremissionphase2.com,
or visit www.WesternUnionRemissionPhase2.com.
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Completed 6 July 2022

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