Fraud Incident Report

Thank you for reporting this incident. Your information helps us understand and combat fraud. Please provide as much detail as possible.

  • A red asterisk (*) indicates a required field.
  • All other fields are optional. Please provide all requested information if possible, but these fields may be left blank.
  • Do not not provide complainant Personally Identifiable Information (PII) such as Social Security numbers or dates of birth anywhere in this form.

I. Incident Details



 

   

II. Financial Loss (If Applicable)

   

Account Name, Account Number, Recipient Name, Platform Name

   

III. Perpetrator Details (If known)

   

Name(s) Email address(es), Phone number(s), Social media profiles, Website(s), Physical address(es), Any other identifying details.

   
   

IV. Reporting and Awareness

   

V. Your Information (helpful for follow-up and to access progress report)




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