9255 Corbin Avenue
Suite 200
NORTHRIDGE CA 91324-2401
(800)
743-2524 
818-782-5887 Fax:
818-734-7847
Request for FIMAT Services
From ___________________________ Company: ____________________________ Date: _______________
Telephone Number: ___________________________________ E-Mail address: ________________________
Insured: _________________________ Loss Date: ___________________________ Policy No: __________
Claim No: ____________________________________ Other: ______________________________________
We request the services of Fraud Investigation Management & Training Company in the following particulars:
We enclose, for your assistance, the following documents that should be part of your investigation:
When reporting a claim to FIMAT remember each indicator or red flag is important. Attach to this form the Indicators form.
Last Updated August 18, 2007