Fraud Report Form - Queensland Australia

This fillable "Fraud Report Form" is a document issued by the Queensland Police Service specifically for Queensland residents.

Download the PDF by clicking the link below and complete it directly in your browser or through the Adobe Desktop application.

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Privacy & Confidentiality Notice
The information in this document is intended for the information of the Queensland Police Service only.
If you are not the intended recipient please return this document to the nearest Police Station and disregard its content.
QUEENSLAND POLICE SERVICE
FRAUD REPORT FORM
This form is designed to assist with the reporting of fraud complaints that do not
constitute a Cybercrime.
Cybercrime offences should be reported online via www.ACORN.gov.au
Please note that Cybercrime includes crimes:
i.
Directed at computers or other devices (such as hacking); and
ii.
Where computers or other devices are integral to an offence (such as
online scams / frauds).
Completed Fraud Report Forms and attachments can be returned to your local
Police Station: Station Locator - Browse
Surname
OFFICE USE ONLY
Given Name(s)
DATE RECEIVED:
Date of Birth
OFFICER REG:
Title/Position
Organisation & Trading Name
OCCURRENCE NO.:
ABN
QP
Address
CORRESPONDENCE NO:
Post Code
Phone
Fax
Mobile
Email
Page 1 of 10
Privacy & Confidentiality Notice
The information in this document is intended for the information of the Queensland Police Service only.
If you are not the intended recipient please return this document to the nearest Police Station and disregard its content.
QUEENSLAND POLICE SERVICE
FRAUD REPORT FORM
This form is designed to assist with the reporting of fraud complaints that do not
constitute a Cybercrime.
Cybercrime offences should be reported online via www.ACORN.gov.au
Please note that Cybercrime includes crimes:
i.
Directed at computers or other devices (such as hacking); and
ii.
Where computers or other devices are integral to an offence (such as
online scams / frauds).
Completed Fraud Report Forms and attachments can be returned to your local
Police Station: Station Locator - Browse
Surname
OFFICE USE ONLY
Given Name(s)
DATE RECEIVED:
Date of Birth
OFFICER REG:
Title/Position
Organisation & Trading Name
OCCURRENCE NO.:
ABN
QP
Address
CORRESPONDENCE NO:
Post Code
Phone
Fax
Mobile
Email
Page 1 of 10
Privacy & Confidentiality Notice
The information in this document is intended for the information of the Queensland Police Service only.
If you are not the intended recipient please return this document to the nearest Police Station and disregard its content.
Dear Sir/Madam,
This form is a very important investigative tool. It will assist police in processing
your complaint. It may also form the basis of your evidence in the form of a witness
statement to be presented at court. Please complete the attached form with as much
detail as possible. Any conversation you have has with the suspect/s should be
recorded in the first person (in an I said, “………” He said, “…...” format. First
person conversations are vital in proving many fraud offences.
If you have consulted a legal practitioner regarding this matter, their assistance may
be valuable with preparing the information requested.
After completion of this form, you will need to return it to your local QPS Police
Station. The following hyperlink may help you locating local; police station:
Station
Locator - Browse
When you return the form, an assessment of the available evidence will be conducted.
You may be contacted for further information if necessary. The information will be
assessed to determine if the matter is of a criminal or civil nature.
Many instances where people lose money are not criminal, but civil, particularly in
matters involving breaches of contract, or non-payment of debts. Police cannot
investigate civil matters. Please be aware that police are unable to recover your
money.
Police investigate criminal matters in order to place evidence before a court. They
cannot be involved in debt collection. Civil action is the most appropriate method of
recovering money. You should speak to the Clerk of the Local Court, which can be
located at the following link:
Courthouses contacts - Queensland Courts
or a solicitor
if you want to take civil action.
If the matter is of a criminal nature, the most appropriate level of response will be
identified. This is achieved by prioritising the matter in terms of urgency, risk and
whether specialist support of experts is needed (as is the case in certain highly
complex matters). Depending on the circumstances of your matter, the correct
jurisdiction for investigation and prosecution may be interstate, overseas or with
another agency. In such instances, your matter may be referred by the QPS to the
appropriate enforcement agency for further action.
If after assessing your complaint it is determined that it will be investigated by the
QPS, the information will be placed on the QPS case management system called
QPrime. You will be provided a report number starting with QP……….which you
will need to quote in any future correspondence.
Please be aware that the Queensland Police Service investigates a wide range of
crimes. It may be that police will have to attend to those types of crimes before we
can attend to yours. An officer will keep in touch with you and inform you of the
progress of your complaint.
Page 2 of 10
Privacy & Confidentiality Notice
The information in this document is intended for the information of the Queensland Police Service only.
If you are not the intended recipient please return this document to the nearest Police Station and disregard its content.
SUMMARY OF ALLEGATIONS
Please provide a brief summary of the fraud allegations that you are making. The purpose of this
information is to provide the reader with a précis of what the actual criminal allegations are. A
more comprehensive account of the allegations will be requested later in this form.
FINANCIAL/PROPERTY LOSS
$
Actual Total Loss
Losses Recovered to Date
Property description
$
(include model/serial/identifiers)
What is the aim in reporting this matter to the Police?
Page 3 of 10
Privacy & Confidentiality Notice
The information in this document is intended for the information of the Queensland Police Service only.
If you are not the intended recipient please return this document to the nearest Police Station and disregard its content.
COMPREHENSIVE SUMMARY OF ALLEGATIONS
This is intended to be a chronological summary of events that form the basis of your criminal
allegations. It is important to include times, dates and places and also details of conversations you have
had with the suspect/s regarding the allegations. It is important this information is factual, as you may
be required to give evidence in relation to the information provided in this report. Attach report or add
further pages if required.
If you refer to documents or other exhibits in your summary, then please clearly label them and cross
reference to the summary. If you are in possession of original documents or material then they should
be preserved – only label and attach copies.
Page 4 of 10
Privacy & Confidentiality Notice
The information in this document is intended for the information of the Queensland Police Service only.
If you are not the intended recipient please return this document to the nearest Police Station and disregard its content.
SUSPECT/PERSON OF INTEREST/OFFENDER
Name – 1 __________________________
Date of Birth _____________________
Address ___________________________
Phone (H) _________________________
Phone (Other) _____________________
Mobile _________Email ____________
Please supply any/all other particulars which may assist in identifying the alleged suspect (ex. vehicles
owned, whether or not married, children, contact telephone numbers, associates, locations frequented,
email and IP addresses, web pages, companies, bank accounts and any other information which may
assist in an investigation)
Name – 2 __________________________
Date of Birth _____________________
Address ___________________________
Phone (H) _________________________
Phone (Other) _____________________
Mobile _________Email ____________
Please supply any/all other particulars which may assist in identifying the alleged suspect (ex. vehicles
owned, whether or not married, children, contact telephone numbers, associates, locations frequented,
email and IP addresses, web pages, companies, bank accounts and any other information which may
assist in an investigation)
Page 5 of 10

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