Anonymous Insurance Fraud Reporting Form

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InterTrace Investigations

PO Box 508

Southampton, MA 01073

1.888.818.8938

Anonymously Report Insurance Fraud... Anonymously Report Workers Compensation Fraud...Anonymously Report Disability Fraud... Surveillance Experts... Worker's Comp. Surveillance... Auto Accident Insurance Surveillance... Disability Surveillance... Liability Surveillance... Insurance Fraud Surveillance... SIU... Insurance Fraud Investigations... Worker's Comp. Fraud... Disability Fraud... Liability Fraud... Auto Accident Fraud...

Insurance Fraud

Do you know someone committing Insurance Fraud? Would you like to report someone anonymously?

Do you know someone who is committing worker's compensation fraud?

Do you know someone who is committing Disability fraud?

Do you know someone who is committing Liability fraud?

Fill out our Anonymous reporting form and we will Investigate the claim and forward it to the proper authority.

Insurance Fraud Investigations Reporting Form

Suspect's Information

First Name:

Last Name:

Address:

City: State

Claimed Injury:

DESCRIPTION:

Approximate Age: Height:feet inches Weight: Hair color:

Mustache: yes no Race: Beard: yes no

Glasses: yes no Sex M F

Marital Status

Does the Claimant have a known History of Violent Behavior? yes no

What is the name or Business or Company the Insurance Fraud Suspect is out from?

Street Address :

City :

State :

Case Type:

We have a Guaranteed 10 day turn around time on all cases!