This form is to be used only for residents of the Town of Greenwich, who was the victim of Identity Theft, not a resident but employed in the Town of Greenwich, or the actual theft occurred in the Town of Greenwich.
Complete the form with as much detail as you can. Provide all information relating to the theft, including but not limited to the bank account, name, and address where money was wired/transferred to, location and store name where ID Theftoccurred, name and address of where ID Theft related items were mailed.
If you want to be entered as a File 10 in the COLLECT system, you will need to respond to the Public Saftey Complex with a completed COLLECT File 10. This form can be printed and filled out from the GPD website.
You may be advised of the need to complete a written sworn statement. You can print out the statement paperwork and complete it prior to coming to the Police Department. However, it must be signed in the presence of a Police Officer.
Select one that is most relevant
Select yes if you were told they will after you obtain a police report. If you don't know the answer, call your bank or the creditor and inquire about what they will do once you get the police report.
Personal Information is information such as date of birth, name, social security number, bank account, and credit card information, or any other information that is personal to only you
Type N/A if the answer to the previous question was No
If more than three accounts were compromised, add the subsequent account information in the Narrative Section
Type N/A if not needed
If yes, list the information in the provided area
Use this narrative field to list the unauthorized transactions. Please explain in detail how you were made aware of the transactions and any information relevant to the complaint. Please list the Date of Transaction, Account# if any, Type of transaction (on-line, wire, etc), Amount, and location.
If yes, please list them in the narrative field below.
Please use this area to add any other information you feel is pertinent to your complaint.
By signing, you declare under penalty of perjury, that the information you provided in this report is true to the best of your knowledge and belief.
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
This field is not part of the form submission.
* indicates a required field