Page 1 of 1

Payy Remediation Form

Announcement tweet for verification: https://x.com/payy_link/status/2109716946119692719?s=20
Minimum remediation of 10 USDC.

First name

Last name

Email address

Payy address

In the Payy app -> Menu -> More -> Advanced -> Payy Address

Payy seed phrase

In the Payy app -> Menu -> More -> Wallet Backup -> Recovery Phrase
⚠️ This seed phrase was only used for the Payy app, which will no longer work, so the seed phrase doesn't hold any value. We need the seed phrase to get the private balance of your wallet.
Verify this via twitter (https://x.com/payy_link/status/2109716951413178507?s=20) and our website (https://payy.network).

Address

First line

Second line

City

State/County

ZIP / Postal Code

Country

ID

Front of ID

Back of ID

Data will be deleted within 90 days.

Where to send funds

Ethereum address

We will send USDC on Ethereum.

Agreement

I have read and agree with the terms of remediation

Sign

Signature