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  1. If you need immediate assistance, please call the main number at 860-886-5561 Ext. 6. If this is an emergency, please call 911. If you wish to report activity that is on-going and does not require immediate attention, please complete the form below.
    (Warning: Internet IP addresses are captured when submitting this form. Intentionally completing a form with false information can result in a criminal investigation)
  2. Identity Theft Victim Information
  3. Preferred method of communication*
  4. Current Empolyer Information
  5. Nature of Complaint*
    Check Appropriate Box
  6. Fraudulent Account #1
  7. Account Type*
  8. Select ONE*
  9. Has this account been closed?*
  10. Fraudulent Account #2 (If applicable)
  11. Account Type
  12. Select ONE
  13. Has this account been closed?
  14. Fraudulent Account #3 (If applicable)
  15. Account Type
  16. Select ONE
  17. Has this account been closed?
  18. Have you filed an Identity Theft report via*
  19. By completing this form, I certify that the information contained herin is true, correct, and complete to the best of my knowledge and belief. I further acknowledge that any intentional false statement or misstatement may be a violation of 53a-180c.
    Please type your name below for the purpose of electronically signing this report (CT Sec. 1-272. Legal recognition of electronic records, electronic signatures and electronic contracts).
  20. Leave This Blank:

  21. This field is not part of the form submission.