A.	Please provide a brief commentary about actions taken to prevent and detect internal fraud during this reporting period. (Provide additional sheets if necessary):

B.	Please provide a brief commentary about actions taken to prevent and detect external fraud during this reporting period. (Provide additional sheets if necessary):

*C.	Are underwriting and claim files maintained under Security? _________________ If yes, please describe briefly (Provide additional sheets if necessary):

*D.	Please provide a brief commentary about your measures to secure electronic systems and data. (Provide additional sheets if necessary)

E.	Please provide a brief commentary about the amount of resources committed to combating fraud during this reporting period. (Provide additional sheets if necessary)

II. FRAUD INVESTIGATIONS

	Please provide a brief commentary about your investigative staff and/or outside service provider. (Provide additional sheets if necessary)

III. REFERRAL OF FRAUDULENT ACTIVITY TO LAW ENFORCEMENT

	Please provide a brief commentary about the type of cases uncovered and prosecuted in this report period. (Provide additional sheets if necessary)

IV. CIVIL ACTION AGAINST FRAUDULENT ACTIVITY

	Please provide a brief commentary about the type of cases uncovered and prosecuted in this report period. (Provide additional sheets if necessary)

*V. FRAUD DETECTION TRAINING

	Please provide a brief commentary about monitoring procedures and frequency of departments to ensure procedures are being properly addressed. (Provide additional sheets if necessary)

VI. STATISTICS

	Please identify the lines of insurance (e.g. private passenger auto, commercial general liability) for which data are included in this report:


A. Policy Data
	1.	# of policies in force at end of year:
	2.	# of new applications received during year:
	3.	# of fraudulent applications:


B. Claim Data
	1.	# of claims received:
	2.	# of suspected fraudulent claims:
	3.	# of fraudulent claims denied:
	4.	Estimated dollars recovered:


C. Referrals/Prosecutions
	1.	Civil actions:
	2.	Federal law enforcement:
	3.	State/local law enforcement:
	4.	Non-insurance professional (Please identify category):
	5.	Other:


D. Internal Fraud
	1.	# of internal fraud cases:
	2.	Dollars recovered:

*VII. WE WANT TO BE ABLE TO CONTACT YOU

NOTE: State of Washington Office of the Insurance Commissioner would like to be able to send e-mail to you. Below, please provide a listing of your e-mail addresses for key personnel. Thank you for your cooperation:

Contact Type	Name	Internet E-Mail Address	Phone

General
Legal
Rates & Forms
Fraud

VIII. CONTACT PERSONNEL

I, _____________________________________, _________________

Print Name

Print Title

certify this report and schedules are true and accurate, to the best of my knowledge. I further attest that any changes to our filed Anti-Fraud Plan have been properly filed with the Office of the Insurance Commissioner.

Signature

Date

Address:

City

State

Zip Code

(Area Code) Telephone Number

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