Please answer the questions below and be as complete as possible. If you wish to remain anonymous you may, but if not, your identity will be kept strictly confidential.

A sample of a completed Hotline Tip Form is available for your reference.

When you complete your answers to the questions, select the "Send comments" button. This will cause electronic mail to be automatically sent to the IFB.

If you are not using a "forms capable" world wide web client program, then we would be grateful if you could email the same information.

IFB Hotline Tip Form

Please enter your comments in the spaces provided below. Thank you in advance for your cooperation.

Name of the person or company you are reporting:

Do you know the person or company's address?

Do you know the person or company's telephone number?

Do you know the person's social security number?

Do you know the person's date of birth or approximate age?

Do you know the person's employer's name and address?

Does the person use any other names or alias' such as a maiden name?

What type of insurance is it?

Do you know who the insurance company is?

Do you know what date the incident occurred or the approximate calendar time period?

Why do you feel this may be a fraudulent claim?

Briefly describe the incident.

You may remain anonymous, but if you wish to leave your name and daytime phone number, please do so.

You may also leave your e-mail address, if you wish to do so.