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Classification 484(g) PC 530.5 PC ALHAMBRA POLICE DEPARTMENT Financial Crime Report DR Number UCR INSTRUCTIONS 1. If the suspect is known, contact this Department by calling (626) 570-5151. 2. Please provide copies of bank statements, credit card statements, checks (both sides), credit reports (Equifax, Experian, Trans Union), affidavits of forgery, and any related correspondence. 3. Include originals or copies of all available documents at the time of your initial report. 4. After completing the form and gathering the required documents, bring them to the Police Department, Sign the form and the Waiver in the presence of a Police Department employee. Be prepared to show proper identification. We are located at: Alhambra Police Department, 211 S. First Street, Alhambra, CA 5. If you have any questions, contact the Detective Section at (626) 570-5157 or (626) 570-5161. FINANCIAL CRIMES INVOLVES UNAUTHTHORIZED USE OF CHECK CREDIT CARD IDENTITY( NAME SS# DL/ID #) IF INITIALLY LOST OR STOLEN, WAS A POLICE REPORT MADE? Yes No If yes, which Law Enforcement Agency took the report? Case Number Investigating Officer Phone # WHERE DID THE UNAUTHORIZED USE OCCUR? (BUSINESS NAME AND ADDRESS) WHEN DID THIS HAPPEN? BETWEEN THE FOLLOWING DAYS/DATES/TIMES FROM: WHAT IS YOUR NAME? (LAST, FIRST, MIDDLE) TO: DATE OF BIRTH (MO/DAY/YR) SOCIAL SECURITY # DRIVER LICENSE OR ID # RACE MALE FEMALE WHAT IS YOUR ADDRESS? (STREET, CITY, STATE, ZIP) HOME: PHONE NUMBERS HOME ( ) BUSINESS: WORK ( ) CELL ( ) THE FOLLOWING ITEMS ARE ATTACHED: Bank Statements Credit Card Statements Checks (copy both sides) Credit Reports Affidavit of Forgery Related Correspondence Other (Describe) Financial Institution Name and Address Contact Person: Phone Number: Alternate Name/Number: Account Number: PC 530.8 WAIVER I understand that in order to adequately investigate this case, it may be necessary for the Alhambra Police Department to request bank statements, credit reports, loan documents, etc. I hereby authorize the Alhambra Police Department to act as my agent concerning all matters related to this case or any associated Financial Crime. I request that any business, agency, or person with information or documents concerning this case, provide that information to the Alhambra Police Department upon their request. I certify under penalty of perjury that the foregoing is true and accurate to the best of my knowledge. Signature (Sign in the presence of Police employee) Field Verification of Victim Identity By: CA Driver s License CA Identification Card Passport Other Copy of DL Attached If not, complete Field Verification X Copy of SS Card Attached Financial Crime Leaflet Provided to Victim Witness/Officer Signature/ID Follow-up letter mailed to Victim Accepted by: /Time Accepted: Approved by: RM S by: Copy to Victim by Copies to Detectives (2)

ALHAMBRA POLICE DEPARTMENT Financial Crime Report Narrative Provide a Clear and Concise Statement of the Facts surrounding the crime: DR Number I certify under penalty of perjury that the foregoing is true and accurate to the best of my knowledge. Signature X

IDENTITY THEFT VICTIM S FRAUDULENT ACCOUNT INFORMATION REQUEST Made pursuant to California Financial Code 4002 and 22470, Civil Code 1748.95 and Penal Code 530.8 TO: ACCOUNT NO: FAX: REFERENCE NO: FROM: I am formally disputing an account that I have learned has been opened or applied for with you. I did not open or apply for this account and have not authorized anyone else to do so for me. You may consider this account to be fraudulent. Below is my identifying information. I have filed a report with my local police department and a copy is attached. Under California law, all credit grantors and utilities must provide information relating to fraudulent accounts opened or applied in an identity theft victim s identity, including a copy of the application and a record of the charges associated with the account. A copy of the relevant California law is enclosed. In most cases, the account information, must be provided free of charge within 10 business days of your receipt of the police report and the victim s identifying information. The victim is generally permitted to authorize your release of the account information to a specified law enforcement officer. I am designating Alhambra Police Department and the detective listed below as additional recipients of all account information and documents. I authorize the release of all account documents and information to the law enforcement officer designated. I am requesting the following: Application Records or Screen Prints of Internet/Phone Applications Statements Payments/Charge Slips Investigator s Summary Delivery Addresses Any other documents associated with the account All records of phone numbers used to activate the account or used to access the account Name: Social Security Number: Address: Phone: Employer: Designated Police Department: Fax: Phone: Report Number: Designated Investigator: Signed: :

INFORMATION FOR IDENTITY THEFT VICTIMS If you suspect that your personal information has been hijacked and misappropriated to commit fraud or theft, take action immediately, and keep a record of your conversations and correspondence. There are three basic actions that you will want to take: 1 Contact the fraud departments of each of the three major credit bureaus. Tell them that you re an identity theft victim. Request that a fraud alert be placed in your file, as well as a victim s statement asking that creditors call you before opening any new accounts or changing your existing accounts. This can help prevent an identity thief from opening additional accounts in your name. At that time, order copies of your credit reports from the credit bureaus. Credit bureaus must give you a free copy of your report if your report is inaccurate because of fraud; you will need to request it in writing. Review your reports carefully to make sure no additional fraudulent accounts have been opened in your name or unauthorized changes made to your existing accounts. Also, check the section of your report that lists inquiries ; where it indicates any of the company(ies) that opened fraudulent account(s), request that these inquiries be removed from your report. In a few months, order new copies of your reports to verify your corrections and changes, and to make sure no new fraudulent activity has occurred. 2 Contact the creditors for any accounts that have been tampered with or opened fraudulently. Creditors can include credit card companies, phone companies and other utilities, banks and other lenders. Ask to speak with someone in the security or fraud department of each creditor. Follow up with a letter, as that is the consumer protection procedure the law spells out for resolving errors on credit card billing statements. Immediately close accounts that have been tampered with, and open new ones with new Person Identification Numbers (PINs) and passwords. Avoid using easily available information like your mother s maiden name, your birth date, the last four digits of your SSN or phone number, or a series of consecutive numbers. Be creative. 3 File a report with your local police. Get a copy of the police report in case the bank, credit card company or other victim businesses need proof of the crime. Even if the police don t catch the identity thief in your case, having a copy of the report can help you when dealing with creditors. You may want to contact the police in the community where the identity theft took place, to see if it is their agency s practice or policy to pursue these types of leads; it varies from department to department.

YOUR NEXT STEPS There is no question that identity thieves can wreak havoc on your personal finances, but there are some things you can do to take control of the situation: STOLEN MAIL If an identity thief has stolen your mail to get new credit cards, bank and credit card statements, pre-screened credit card offers or tax information, or if an identity thief has falsified change-of-address forms, that is a crime. Report it to your local postal inspector. Contact your local post office for the nearest postal inspection service office or check the website at https://postalinspectors.uspis.gov, under CONTACTS select Nearest Office. CHANGE OF ADDRESS ON CREDIT CARD ACCOUNTS If you discover that an identity thief has changed the billing address on an existing credit card account, close the account. When you open a new account, ask that a password be used before any inquiries or changes can be made on the account. BANK ACCOUNTS If you have reason to believe that an identity thief has tampered with your bank accounts, checks or ATM card, close the accounts immediately. When you open new accounts, insist on password-only access, if that is not already the bank s policy, to minimize the chance that an identity thief can violate the accounts. In addition, if your checks have been stolen or misused, stop payment. Also contact the major check verification companies to request that they notify retailers using their databases not to accept these checks, or ask your bank if this is something they automatically do. Three of the check verification companies that accept reports of check fraud directly from consumers are: Telecheck: 1-800-710-9898 International Check Services: 1-800-631-9656 Equifax: 1-800-437-5120 If your ATM card has been lost, stolen or otherwise compromised, cancel the card as soon as you can and get another with a new PIN. INVESTMENTS If you believe that an identity thief has tampered with your securities investments or a brokerage account, immediately report it to your broker or account manager and to the Securities and Exchange Commission. PHONE SERVICE If an identity thief has established new phone service in your name, is making unauthorized calls that seem to come from and are billed to your cellular phone, or is using your calling card and PIN, contact your service provider immediately to cancel the account and/or calling card. Open the new accounts and choose new PINs. If you are having trouble getting fraudulent phone charges removed from your account, contact your state Public Utility Commission for local service providers or the Federal Communications Commission for long-distance service providers at www.fcc.gov or 1-888-CALL-FCC. CRIMINAL RECORDS/ARRESTS In rare instance, an identity thief may create a criminal record under your name. For example, your imposter may give your name when being arrested. If this happens to you, you may need to hire an attorney to help you resolve the problem. The procedures for clearing your name vary by jurisdiction.

CHART YOUR COURSE OF ACTION Use this form to record the steps you ve taken to report the fraudulent use of your identity. Keep this list in a safe place for references. Credit Bureaus Report Fraud Bureau Phone Number Equifax 1-800-525-6285 Contacted Contact Person Comments Experian 1-888-397-3742 Trans Union 1-800-680-7289 Banks, Credit Card Issuers and Other Creditors (Contact each creditor promptly to protect your legal rights) Creditor Address & Phone Number Contacted Contact Person Comments Law Enforcement Authorities Report Identity Theft Agency/ Department Federal Trade Commission Local Police Department Phone Number 1-877-IDTHEFT Contacted Contact Person Report Number Comments