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Please provide as much information as possible.

Your Contact Information
* Denotes required fields

First Name *
Last Name *
Phone *
Email *
   
   
  Phone Type: *    
   
Remain anonymous:    

You may report anonymously. If so, please provide as much information as possible. If a report does not include enough information, we may not be able to start our investigation.


Information about the Individual/Business Suspected Committing Fraud

Subject Type: *        Is this an:    *

Last Name or Business Name: *
First Name
Middle:
Street Address:
City:
State:
Zip:
Phone:
Email:
DOB:
SS#:
VIN:
License Plate # / State:
Vehicle Year:
Make:
Model:
    Phone Type:
 
 


Information on Additional Individual/Business

Subject Type:        Is this an:   

Last Name or Business Name:
First Name
Middle:
Street Address:
City:
State:
Zip:
Phone:
Email:
DOB:
SS#:
VIN:
License Plate # / State:
Vehicle Year:
Make:
Model:
    Phone Type:    
 

Information on Suspected Fraud

Where did suspected fraud occur? (if known)
Street Address:
City:
State:*
Zip:
Date the suspected fraud occurred:
 

Reason for Report

Provide facts about the suspected fraud such as: *
    What happened?
    How did you find out about it?
    Why do you think it is insurance fraud?


2500 Char Max

Files to upload


Select a file (.doc, .docx, or .pdf) to attach


Agree and Submit

To the best of my knowledge, the information contained herein is true and accurate. I understand that the information I have supplied may be used as part of an Idaho Department of Insurance inquiry or investigation, or may be given to other local, state, or federal agencies.
Please check the box below to indicate that you agree to the statements in this paragraph.

I Agree

If you would like a copy of your complaint please PRINT it before hitting the “Submit” button. Please click on Submit Complaint only once, and wait patiently. It may take some time for our system to process your entry. You will receive a confirmation if the form has successfully completed.