Get Nys Dfs Ifb 1 Form

Filling out the Nys Dfs Ifb 1 Form online is an essential step in reporting insurance fraud in New York State. This guide will provide you with clear and comprehensive instructions to help you complete the form accurately.

Follow the steps to complete the form effectively

1. Click the ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by providing the information of the person furnishing the report, including their name and address. This helps identify the reporting individual.
3. In the section labeled 'Brief statement of suspect transaction', fill in the date of loss, amount of loss, and specify the county. Choose the type of loss from the provided options such as Auto, No-Fault, Medical, Workers Comp, Fraudulent ID cards, or Other.
4. If applicable for Auto or No-Fault, indicate whether the policy application was submitted via NYAIP by selecting Yes or No.
5. Identify the parties involved in the suspect transaction. Provide their names and addresses. If the loss is related to Auto or fraudulent cards, include the Vehicle Identification Number (VIN) and the plate or license number.
6. Record your policy, claim, or reference number related to the transaction. This may include Claim #, Claim status, Reference #, Policy #, and SIU #.
7. Fill out the contact information of the individual in your company who can provide further details, including their name, title, address, and telephone number.
8. Indicate whether you have reported this transaction to any other law enforcement agency by selecting Yes or No. If Yes, provide the agency's name, address, the person contacted, their telephone number, and the date of the report.
9. If you need more space, continue on the reverse side or attach additional sheets as necessary.
10. Finally, ensure that you sign the form and include your title before submitting it.

Complete and submit your documents online today to ensure timely processing.