Report Insurance Fraud
Please complete this form to the extent possible.
Name of person/company suspected of fraud:
If person date of birth:
Name of RLI entity/insurance company
that is the target/victim of suspected fraud:
Claim number, if known:
Policy number, if known:
Brief description of suspected fraud:
Although we encourage you to provide us with your contact information, that is not required to complete and file this report.
May we contact you with additional questions or to discuss further:
Your contact information will remain anonymous throughout our investigation.
Type case sensitive characters shown to verify.
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