Fraud and Arson Award Program

Your Information

Name:

Address:

City, State, Zip:
   
Phone:

Email:

Nominee Information (if different)

Name:

Address:

City, State, Zip:
   
Phone:

Email:

Fraud/Arson Information

Date of Loss:

Location of Loss:

Amount of Loss:

Insurance Provider:

Insurance Provider Contact:

Insurance Provider Address:

Name of Suspect:

Date of Arrest/Conviction:

Remarks (Legal Jurisdiction/Disposition/Sentence)

A committee established by Grinnell Mutual Reinsurance Company shall be the sole judge of whether the information provided is truthful, credible and of material assistance in identifying the arsonist or individual committing fraud.

If you have additional supporting documentation, please send it to:

Arson/Fraud Alert Steering Committee
Phone: 800.362.2041 Ext. 8265
Fax: 641.236.2828
E-Mail: fraud-arson@gmrc.com