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STRICTLY CONFIDENTIAL ATTORNEY / CLIENT PRIVILEGE Report Fraud / Confidential Report Form Note: This form is to be used only to evaluate your claim and/or make a referral to legal counsel. It is not a commitment to provide legal representation. Regardless of our evaluation, the contents of the form shall remain confidential. If you do not wish to submit this form via email, you may use this printable form to send it via fax or US mail. Comments or questions are welcome.

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