New York Form Ifb 1 PDF Details

In the realm of combating insurance fraud in New York, the New York State Department of Financial Services plays a pivotal role, not least through instruments such as the Insurance Frauds Bureau Form 1 (IFB-1). This form acts as a crucial first step in the process, allowing businesses and individuals to report suspicious insurance-related activities directly to the state's watchdog. Located at the heart of New York, the Department's headquarters on 25 Beaver Street in New York, NY, 10004, has made it their mission to meticulously process the information provided on these forms to protect the integrity of the insurance market and safeguard consumers. The IFB-1 form itself comprises several sections aimed at capturing a comprehensive snapshot of the suspected fraud, including details of the informant, a brief statement of the suspicion, specifics about the suspect transaction such as the date of loss, amount involved, and the nature of the claim, along with any pertinent identification numbers related to vehicles or policies. Additionally, it seeks information on whether the suspicious activity has been reported to any other law enforcement agencies, further emphasizing the collaborative nature of fraud investigation. The requirement for detailed contact information from the reporting party underscores the bureau's commitment to thorough investigation and follow-up, reinforcing the form's role as a vital tool in the fight against insurance fraud in New York State.

QuestionAnswer
Form NameNew York Form Ifb 1
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesifb10811 nys dfs ifb 1 form

Form Preview Example

NEW YORK STATE

DEPARTMENT OF FINANCIAL SERVICES INSURANCE FRAUDS BUREAU

25 BEAVER STREET

NEW YORK, NY 10004

DATE:

1). Information furnished by:__________________________

Address: _______________________________________

_______________________________________

NAIC # _______________________________________

Previously submitted? Yes ____ Log # ___________ No_____

PLEASE PRINT/TYPE INFORMATION

2)Brief statement of suspect transaction. Date of loss ___________ Amount of loss ____________ County_____

Type of loss: Auto___ No-Fault___ Medical___ Workers Comp. __ Fraudulent ID cards__ Other_____________

If Auto or No-Fault, was this policy application submitted via NYAIP? Y N

STATEMENT

3)Identify parties to suspect transaction: Name(s) Address(es)

Additional information on suspect(s)

If Auto or Fraudulent cards give VIN # _________________________ Plate or License # ____________________

4) Identify your policy, claim or reference number under which the above transaction is recorded:

Claim # __________________________ Claim status_____________________________________________

Reference #_____________________________ Policy # _________________________ SIU #_______________

5)Name, title, address & telephone number of individual in your company who can provide detailed information:

NAME__________________________________________ TITLE _________________________________

ADDRESS __________________________________________________ TELEPHONE # _____________

6)Have you reported this transaction to any other law enforcement agency? Yes ____________ No____________

If yes, please furnish: Agency _________________________________________________________________

Address ___________________________________________________________________________________

Person contacted _________________________ Telephone #____________________Date of report _________

Continue on reverse or attach additional sheets as necessary.

Signed: _______________________________

Title: ________________________________

http://www.dfs.ny.gov

IFB-1 REV 8/11

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