Report Fraudulent Activity

Please complete this form to report an incident of fraudulent activity to the SUNY Old Westbury Justice for Fraud Victims Project.

Please complete this form to report an incident of fraudulent activity to the SUNY Old Westbury Justice for Fraud Victims Project.

Who is the victim?

My dependent

Business

Other…

Personal information

First

Last

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Phone

Contact preferences

Phone

Business information

Business name

Business address

Business phone

Victim's information

Full name

Address

Phone

Description of the incident

Do you have video or other evidence of the incident? Please describe.

Location of incident

Date of incident

Please describe any suspect information.

Have you spoken with others who saw or heard anything?

Yes

Explain in chronological order, who did what, when, where, why, and how.