Fraud/ Forgery Investigation Packet Summary Form. Customer/ Claimant Information

Transcription

1 Fraud/ Forgery Investigation Packet Summary Form Documentation Processed by: Employee Name: Facility: Position: Phone: Customer/ Claimant Information Name: Daytime Phone: Address: City: State: Zip: Account # Has the affected account been closed? Yes No Date: Was a new account opened? Yes No Acct. No. Necessary internal notifications made? Yes No Date: Has a Police Report been made? Yes No Report Number: Police Department: _ If the answer to any of these questions is NO, please explain: CHECK LIST FOR BRANCHES 1. Investigation Form---Completed by customer and completed affidavit. 2. Section A---Forgery Summary Work Sheet---Copies or Originals must be attached 3. Please include DPTRANI or Branch Connections Printouts 4. Include originals if mailed in customer s statement. 5. For St. Louis Region Only: a. If the affidavit filled out by the customer involves checks or other fraudulent items cashed at a retail store, the affidavit for those items should be sent to the DDA Department for review (KCDDA). b. If the affidavit filled out by the customer involves checks or other fraudulent items cashed at a branch, send the original to Corporate Security (CLRS) and a copy to Group Operations (WOOP). c. If the affidavit filled out by the customer involves checks or other fraudulent items cashed at both retail stores and a branch, three copies should be made and sent to the DDA Department (KCDDA), Corporate Security (CLRS) and Group Operations (WOOP). 6. For All Other Regions: a. If the affidavit filled out by the customer involves checks or other fraudulent items cashed at a retail store, the affidavit for those items should be sent to the DDA Department for review (KCDDA). b. If the affidavit filled out by the customer involves checks or other fraudulent items cashed at a branch, the affidavit for those items should be sent to your Group Ops Department. c. If the affidavit filled out by the customer involves checks or other fraudulent items cashed at both retail stores and a branch, two copies should be made (One sent to KCDDA, one sent to Group Ops).

2 Fraud / Forgery Investigation Form (To Be Completed By Customer/ Claimant) Please Print: In your own words, please indicate how you think this fraud/ forgery occurred, who you think committed or may have been involved in this crime, and how they obtained the check(s) and / or information to accomplish this fraud/ forgery. Please answer the following questions completely. DO NOT leave any question blank. Enter N/A where the question does not apply to your particular situation. 1. Was/ were the check(s) ever in your possession prior to the fraud/ forgery? Yes No If, Yes, where did you keep/ store the check(s)? When did you first notice the check(s) missing? 2. Do you believe the check(s) was / were: lost stolen counterfeit? When? Where? How? 3. Who else had access to the checks(s) beside yourself? Name Address: 4. Did you report the theft of loss to the Police? Yes No Report # Police Department Name If you have not made a Police Report, please explain why not 5. Regardless of whether the check(s) was/ were ever in your possession prior to the fraud/ forgery, how do you think it/ they fell into the hands of the perpetrators of the offense? Who do you think took the check(s)? Name Phone 6. Do you know the payee or endorser of the check(s)? Name Phone Address 7. Do you recognize any handwriting, identification, description or any other entry that appears on the check(s) Yes No If yes, who do you identify as the author, or may be involved? Name Phone Address Is there anyone you have not mentioned that you suspect of possible involvement for any reason? Yes No

3 Name Phone: Address Why do you suspect this person(s)? 8. Were any other financial items or personal identification lost or stolen at the same place or time? Yes No. If yes, Please identify the items.. 9. Do you have any other bank accounts, (with this or any other bank), that you feel may also have been comprised as a result of this incident? Yes No If Yes, please identify those accounts: 10. Has anyone been in your home or business where they would have had access to your checks or account information? Yes No If yes, please describe the person(s) and explain the circumstances 11. Have you ever been a victim of this or similar type of crime before? Yes No. If yes, please describe the circumstances of that incident and when it occurred: 12. If received in a bank statement, have there been other forged items mailed by the bank prior bank statements? Yes No If yes, when and to whom did you report them? The information contained in this Fraud/ Forgery Investigation Form is true, accurate and complete to the best of my knowledge and belief. Signature Date

4 Forged or Altered Check Affidavit of Loss (To Be Completed By Customer/ Claimant) Please Print (Note: The filing of a false affidavit is a criminal offense and, in addition, may constitute Bank Fraud under State and/ or Federal Statues.) State of ) County of ) SS. I,, being duly sworn under oath, depose and state as follows: 1. I have personal knowledge of the matters stated herein and have full capacity to make this affidavit: 2. My full address is, And my daytime telephone number is ( ) - 3. I am an authorized signer on Commerce Bank Checking Account Savings Account Account Name Account Number I have fully examined the check(s) described in Section A of the attached Forgery Summary Worksheet, which is incorporated herein, and will further state that: 4. (Check and Complete ONE only) The check(s) was/were not signed by me, and my purported signature, as maker is a forgery made without my consent, knowledge or authorization. The check(s) are counterfeit(s) The check(s) was/were not endorsed by me, and my purported signature, as endorser is a forgery made without my consent, knowledge or authorization. The check(s) has/have been altered without my consent, knowledge or authorization. The check was originally issued payable to: For the amount of (Dollars) $ The check has been altered to read payable to: For the amount of (Dollars) $ 5. I have not received any direct or indirect benefit from the negotiation of said check(s). 6. I agree to complete the Fraud/Forgery Investigation Form and state that all information contained therein is complete, correct and true to my best information. 7. Other than as described on the attached Fraud/Forgery Investigation Form, I have no knowledge as to the identity of the person(s) responsible for the forgery of my name to, or the alteration to the check(s) in question. 8. I understand that Forgery and Check Alteration are crimes and I hereby authorize the use of this Affidavit and/or the associated Fraud/Forgery Investigation Form in any criminal prosecution of any person accused of a crime in connection with the matters described herein or in any civil litigation commenced by any party to recover a loss incurred as a result of the matters described herein; 9. I agree to cooperate fully by participating in any criminal or civil investigation and/or litigation proceedings concerning the matters described herein to include my testifying in court when requested. 10. This affidavit is being given to induce, Commerce Bank to recover the proceeds of the check(s), on behalf, noted in Section A of the attached Forgery Summery Worksheet. 11. I understand that, in order to prevent further losses, the bank may require the account(s) described herein to be closed and may not allow me to reopen or maintain another account with the bank. (Signature of Customer/Claimant) Sworn to and subscribed before me, a Notary Public, in and for the county and State aforesaid this day of, (year) (Notary Public) My Commission Expires

5 Forgery Summary Work Sheet SECTION A: TO BE COMPLETED BY BRANCH List all checks to be incorporated into the attached affidavit. Copy this worksheet as necessary and indicate the number of additional pages attached. Check Number Amount of Check Date on Check Payable To Date of Transaction

6 SECTION B: TO BE COMPLETED BY GROUP OPERATIONS If any check was cashed or approved by an employee (Teller cashed), log the corresponding check number and complete all information. Check Number Employee Involved Position Branch Work Phone

7 SECTION C: TO BE COMPLETED BY THE SECURITY DEPARTMENT Can the Employee Identify the Suspect? Photo or Video of Suspect? Where was the Check Cashed, Deposited or otherwise Negotiated?