Before You Begin:
Filing this form is restricted to legitimate business purposes only. Information will be submitted to the Michigan Department of Insurance and Financial Services (DIFS) Fraud Investigation Unit (FIU) for their review and investigation. DIFS bears no responsibility or liability for the accuracy or veracity of information submitted. Users reporting fraudulent activity through this form will do so in good faith.
By agreeing to continue, you acknowledge the following: that you have read and understand this statement regarding the use of this form; that access or use of this form for fraudulent activity is strictly prohibited by the State of Michigan and the Department of Insurance and Financial Services; that use of this form or the reporting of suspected fraudulent activity which you know to be false, may subject you to criminal or civil penalties/remedies under state, federal, or other applicable domestic and foreign laws.