Suspicious Activity and Fraud Referral Form

To report suspicious activity or a potential incident of fraud to Global Atlantic’s Special Investigations Unit, please complete this form with as much information presently known about the potential fraud being reported and upload copies of all relevant documents with the submission. If multiple files need to be submitted, please use a zip file. Should any new information be discovered after submitting the form, please update Global Atlantic’s SIU at fraud@gafg.com.

General Referral Information

Date suspicious activity was identified

Date of the suspicious activity

Who first reported the suspicious activity

Referral Sender Email Address (Your Email Address)

Suspicious Activity Summary

Type of Suspicious Activity

Summary of facts regarding the suspicious activity and describe the activity observed

Financial Information

Dollar Amount Involved ($)

Possible Fraudster/Perpetrator Information

Possible Fraudster/Perpetrator Name

Possible Fraudster/Perpetrator Address

Possible Fraudster/Perpetrator Phone Number

Possible Fraudster/Perpetrator Email Address

Relationship to the Affected Person

Affected/Impacted Person’s Information

Affected Person Name

Affected Person Street Address

Affected Person State of Residence

Affected Person Phone Number

Affected Person Email Address

Relationship to Policy

Policy Information

Policy Number(s)

Line of Business

Company

Product

Financial Professional Information

Financial Professional Name

IMO or Broker Dealer

Name of IMO or Broker Dealer

Documentation

Please provide the following documentation: Application, Phone Calls Related to Suspicious Activity, Call History, Policy Comments, Transaction History, Copies of Payments Related to Suspicious Activity, Banking Information, GIACT Report, FraudShare Results Please provide any other documentation and correspondence relevant to the referral. This may include, but is not limited to: Redemption Forms, Policy Change Forms, Forms Containing the Customer's signature, Legal Documentation, Address Change History.*

Do you have any documents that would help to prove this act may be fraudulent?

If multiple files will be submitted, please zip the files and attach to zip file.

One file only.
256 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods, zip.
400 MB limit per form.

Contact us

By email: ReportFraud@gafg.com

By regular mail:
The Global Atlantic Financial Group LLC
ATTN: Special Investigation Unit
20 Guest Street, 9th Floor
Boston, MA 02135

Suspicious Activity and Fraud Referral Form

Contact us

Fraud resources