Joint Crime Report Form

This form is to be used ONLY by Financial Institutions, Law Enforcement or other reporting agencies to report a case of criminal activity or to provide information and intelligence of a ongoing crime.

MAILING INFORMATION FORM:

If your browser does not support FORMS or if you have concerns about sending this information over the internet, please make a copy of this report and forward it either by FAX or by US MAIL.

CONTACT - MAILING INFORMATION:

Call Us
843-571-2143 (Local)
Write Us
National Crime Alert Network
811 Canary Drive
Charleston, South Carolina 29414
Email Us
alert@ckfraud.org


REQUIRED INFORMATION

Crime Being Reported:
Your Full Name:
Your E-Mail Address (REQUIRED):
Contact Phone Number:
Fax Number:

FINANCIAL INSTITUTION INFORMATION:

Financial Institution:
Financial Institution Address:
Your E-Mail Address (REQUIRED):
Submitting Name :
Your Position:
Contact Phone Number:
Fax Number:


LAW ENFORCEMENT AGENCY INFORMATION:

Police Agency Name:
Police Agency Address:
Your E-Mail Address (REQUIRED):
Investigator Name :
Your Position:
Contact Phone Number:
Fax Number:
Beeper Number:


TYPE OF REPORT:

TYPE "Classified" or "For Posting"
Type of Report:

TYPE OF CRIME:

CREDIT CARD FRAUD - CHECK FRAUD - STOLEN CHECK(s) - FORGERY
COUNTERFEIT CHECK - COUNTERFEIT DOCUMENTS - IDENTITY FRAUD
INVESTMENT FRAUD - BUSINESS FRAUD - BANK ROBBERY - ATM FRAUD
THEFT OF YOUR PROPERTY - NEW ACCOUNT FRAUD - SECURITIES FRAUD
OTHER TYPES OF CRIME

Type of Crime being Reported:
Your Case Number if Available:


CHECK DOCUMENT INFORMATION:

The information you provide will enable us to verify any criminal activity in respect to the account number and route number. Should you have any questions regarding these two items, please call our office.

If you are reporting several checks or credit card accounts, it is best that you provide this information in a separate document and forward to us as an attachment.

PERSONAL CHECK - JOINT CHECK - BUSINESS CHECK - CREDIT CARD
COUNTER CHECK- DRAFT - CASHIER CHECK - MONEY ORDER - TRAVELERS CHECKS - OTHER

TYPE OF CHECK INVOLVED -

Was an affidavit of forgery filed with the bank? Yes No
Affidavit File Date:
Is the account closed? Yes No
Date Closed:
Bank Name On Check:
Bank Address On Check:
Bank Official:
Bank Phone Number:
Bank Fax Number:
Business Name On Check:
Account Name On Check:
Account Number:
Route Number:
Check Number:
Check Series Numbers:
Check Date:
Check Amount:
Payable to Whom:
Signed By Whom:

NSF - ACCOUNT CLOSED - SUBMITTED TWICE - STOPPED PAYMENT - LOST OR STOLEN CHECK - FORGERY - COUNTERFEIT - REFER TO MAKER - INVALID SIGNATURE - DO NOT REDEPOSIT - UNCOLLECTED FUNDS - OTHER

REASON CHECK RETURNED -

REASON ACCOUNT CLOSED -


CREDIT CARD INFORMATION

Make sure you have canceled all of your credit cards. You can obtain the credit card company phone number on your last billing statement. If a debit card was stolen, contact your bank "NOW." Your liability is different with a debit card than that of a credit card. If you have questions, call our office.

TYPE OF CREDIT CARD STOLEN-

Did you contact your credit card company? Yes No
Credit Card Company Name:
Credit Card Company Address:
Company Phone Number:
Company Fax Number:
Name On Credit Card:
Card Number:
Expiration Date:


SUMMARY OF EVENTS:

Provide any additional information concerning the above activity or crime.


SUSPECT INFORMATION:

Provide as much information regarding suspect as possible. Should you have a finger print or a picture of the check writer, let us know at once. Pictures of individual and of items used in crime should be forward to us by image form. This can be done if the items have been scanned and can be forward by email attachment. You can also forward image by US Mail. Record any information that was written on the check at the time of acceptance.

Suspect Name:
Suspect Aliases:
Suspect E-Mail Address:
Suspect Full Address:
Suspect Phone:
Suspect Relationship to Victim:
Suspect Driver License (State & Nbr):
Suspect Driver License (State & Nbr) Aliases:
Suspect ID Card (State & Nbr):
Suspect ID Aliases (State & Nbr):
Suspect SSN:
Suspect SSN Aliases:
Suspect DOB:
Suspect DOB Aliases:
Suspect Race:
Suspect Sex:
Suspect Height:
Suspect Weight:
Suspect Hair:
Suspect Eyes:
Other Features (scars/marks/tattoos):


VEHICLE INFORMATION:

If a vehicle was used in the crime, provide details below.

License Number:
License Number State:
Auto Make:
Year:
Body Style:
Color:


NARRATIVE:

PROVIDE WHAT YOU CAN. WE DO NOT INTEND TO GET INVOLVED IN YOUR CASE UNLESS YOU SUBMIT A REQUEST FOR ASSISTANCE.

Submit a brief narrative of your case. Make sure you list all the information you have regarding the incident or crime. If an arrest warrant has been issued, please indicate the warrant number, date it was issued, issued by whom, and the name of the Police Department involved. If you have knowledge that another PD or a federal agency is involved, please provide contact information. If suspect has been arrested and you are seeking additional information, make sure to indicate date of arrest, where suspect is currently being held, current holds. Indicate your state CID number and FBI number if known.


By submitting this form, you hereby authorize the National Check Fraud Center and the National Crime Alert Network to release the above information to respective Financial Institution, Police or Federal agency that has jurisdiction in this matter and or to members of the National Crime Alert Network. Make sure you have indicated at the top of this report if the information you are submiting is either CLASSIFIED or To Be Posted.

BEFORE YOU SUBMIT YOUR DATA, PLEASE REVIEW YOUR ENTRIES


For Assistance, Call

843-571-2143

To Send a Fax

843-571-2143

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