We can't see a filled out form of this type: https://docs.google.com/forms/d/e/1FAIpQLSe2-G5FlJRRLgcbPViPvwF7kY7yIw_KmOkvE41yBkcMjLv5Dw/viewform

We need to be sure the withdrawal is not made to an exchange wallet address, in case that does not exist any more. On line numbers, put 1227 and 3340.