Can this form be signed electronically?

Yes. Electronic signatures are generally enforceable under the ESIGN Act (15 U.S.C. §7001) and state UETA statutes so long as the signer demonstrates intent, consents to an electronic record, attribution is established, and a reproducible record is retained.

What authentication is recommended?

Use a level of signer authentication that matches the risk: email or SMS for low-risk disclosures, and ID credential analysis, KBA, or video verification for high-risk or regulatory matters.

How should I handle disclosures with PHI?

When disclosures include protected health information, ensure a Business Associate Agreement (BAA) is in place, follow HIPAA privacy requirements, and retain records for six years per 45 CFR §164.530(j).

What attachments are most useful?

Include transaction logs, redacted account numbers, screenshots with timestamps, correspondence, and witness contact details; clearly reference attachments in the incident description for context.

Who should sign the disclosure?

The person with firsthand knowledge should sign. If legal counsel or a corporate officer must attest, ensure signatory authority is documented in the file and recorded in routing logs.

How can a disclosure be amended or revoked?

Amendments should be submitted as clearly labeled supplemental disclosures with dates and signatures. Revocation is handled per organizational policy; retain both the original and any revocation for the record.

Electronic Signature
Templates
Miscellaneous
Fraud Disclosure Terms

Fraud Disclosure Terms

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

FRAUD DISCLOSURE TERMS AND BUSINESS AGREEMENT

Client Name: Service Provider Name: Effective Date:

WHEREAS

WHEREAS, Client engages Service Provider to perform certain services described in the Scope of Work below and requires explicit procedures and disclosures concerning the detection, reporting, investigation, prevention and remediation of Fraud; and

WHEREAS, Service Provider acknowledges its obligation to maintain reasonable controls, to notify Client promptly of suspected Fraud, to preserve evidence, to cooperate in investigations, and to indemnify Client for losses arising from Service Provider's failure to comply with these Fraud Disclosure Terms; and

WHEREAS, the parties desire to set forth the terms and procedures by which Fraud is disclosed, investigated and remediated as an integral part of the parties' commercial relationship.

SCOPE OF WORK

Description of Services and Fraud-related Activities

PAYMENT TERMS

Contract Amount Payment Schedule Late Payment Fee

Late fee shall be % per month on overdue amounts, calculated from the due date until paid in full. Any application of late fees shall comply with applicable law and shall not exceed the maximum lawful rate.

TERM AND TERMINATION

Term Start Date: Term End Date:

Termination Notice Period

Either party may terminate this Agreement for cause upon written notice if the other party materially breaches any provision of these Fraud Disclosure Terms and fails to cure such breach within the stated notice period. Termination shall not relieve either party of obligations accrued prior to termination, including obligations related to Fraud investigations and remediation.

FRAUD DISCLOSURE AND RESPONSE OBLIGATIONS

Definitions. For purposes of this Agreement, "Fraud" means intentional deception, misrepresentation, intentional omission, unauthorized access, unauthorized transaction, identity theft, or other wrongful conduct intended to result in financial or reputational harm. "Unauthorized Transaction" means any transfer, payment, or access not authorized by the affected party.

Duty to Notify. Upon discovery or reasonable suspicion of Fraud, the discovering party shall notify the other party without undue delay and, in any event, within hours. The notification shall describe the nature of the suspected Fraud, affected accounts or transactions, and any immediate steps taken to mitigate loss.

Investigation and Preservation. The parties shall preserve all records, logs, footage, communications, and other evidence related to the suspected Fraud for a minimum of days or longer if required by law. Service Provider shall initiate an internal investigation within hours of notification and shall provide status updates to Client at reasonable intervals.

Mitigation and Remediation. If Fraud results in loss to Client, Service Provider shall take commercially reasonable steps to mitigate further loss, which may include temporarily suspending access, reversing unauthorized transactions where feasible, cooperating with financial institutions for chargebacks, and providing provisional credit pending final determination where required by law or agreed in writing.

Cooperation with Law Enforcement. The parties shall cooperate fully with any governmental or law enforcement investigation and shall provide requested documentation and testimony as permitted by law and subject to any required protective measures for confidential information.

REPORTING CONTACTS

Client Fraud Contact — Name Client Fraud Contact — Phone Client Fraud Contact — Email Service Provider Fraud Contact — Name Service Provider Fraud Contact — Phone Service Provider Fraud Contact — Email

CONFIDENTIALITY

All non-public information disclosed in connection with a Fraud incident, including investigation results, supporting evidence, forensic reports and remediation plans, shall be treated as Confidential Information. Neither party shall disclose Confidential Information except as required by law or with the prior written consent of the other party. Confidentiality obligations shall survive termination of this Agreement for a period of five (5) years or for such longer period as required by law.

INDEMNIFICATION

Service Provider shall indemnify, defend and hold Client harmless from and against any and all claims, damages, losses, liabilities, costs and expenses (including reasonable attorneys' fees) arising out of Service Provider's negligence, willful misconduct or breach of these Fraud Disclosure Terms that cause or contribute to Fraud losses suffered by Client. This indemnity is in addition to any other remedy available under law or equity.

LIMITATION OF LIABILITY

Except for liability arising from gross negligence, willful misconduct, fraud, or indemnification obligations under this Agreement, neither party shall be liable for consequential, incidental, punitive or special damages. Each party's aggregate liability for direct damages arising from this Agreement shall not exceed the total fees paid by Client to Service Provider under this Agreement in the twelve (12) months preceding the event giving rise to the claim.

AUDIT AND COOPERATION

The parties shall permit reasonable audits by the other party or a mutually agreed independent auditor limited to records and controls relevant to Fraud detection, reporting and remediation. Audit requests shall be provided in writing with at least days' notice and conducted during normal business hours.

Consent to Audit

By checking this box, the party acknowledges consent to audits as set forth above.

RECORD RETENTION

Each party shall retain transaction records, logs and forensic artifacts sufficient to investigate suspected Fraud for not less than years, or longer if required by applicable law.

GOVERNING LAW

This Agreement shall be governed by and construed in accordance with the laws of the State of , without regard to its conflicts of law principles.

ENTIRE AGREEMENT

These Fraud Disclosure Terms, together with any scope and payment provisions set forth herein, constitute the entire agreement between the parties with respect to the subject matter and supersede all prior and contemporaneous agreements and understandings, whether written or oral. Any modification must be in writing and signed by authorized representatives of both parties.

NOTICES

Client Notice Address Service Provider Notice Address

REPRESENTATIONS AND WARRANTIES

Each party represents that it has full right, power and authority to enter into this Agreement, that the execution and performance thereof will not violate any other agreement by which it is bound, and that it will perform its obligations in compliance with applicable law and reasonable industry standards with respect to Fraud detection and prevention.

ACKNOWLEDGMENT

By signing below, the undersigned parties acknowledge receipt of these Fraud Disclosure Terms, confirm authority to bind their respective organizations, and agree to comply with the obligations and procedures described herein.

Acknowledgment

I acknowledge that I have read, understood and will comply with the Fraud Disclosure Terms.

Comments (optional)

Client Printed Name:

By:

Date:

Service Provider Printed Name:

By:

Date:

What the Fraud Disclosure Terms Are and when they matter

A Fraud Disclosure Terms document records a party's written statement about suspected fraud, detailing the parties involved, the facts observed, and any supporting evidence. It establishes a formal record for internal investigations, insurance claims, law enforcement referrals, or regulatory reporting. The document can be used to preserve timelines, document witness accounts, and authorize information sharing with investigators while also creating a retained record for compliance reviews. Many organizations accept electronically signed disclosures when they meet ESIGN and applicable state UETA/ESRA requirements.

Why a formal fraud disclosure matters for investigations and compliance

A properly completed Fraud Disclosure Terms form creates a clear record that supports fact-finding, protects organizational interests, and documents timely reporting to regulators or law enforcement.

Who typically completes or receives these disclosures

The completed disclosure is routed according to organizational policy and may be shared with auditors, regulators, or law enforcement as appropriate.

Financial institutions and compliance teams that investigate suspicious transactions and prepare Suspicious Activity Reports or internal referrals.
Insurance companies and claims adjusters documenting suspected insurance fraud and gathering claimant statements.
Legal counsel, government investigators, or corporate security teams who require a signed factual statement to support further action.

Step-by-step: completing and submitting the disclosure

Follow these sequential steps to prepare a complete, admissible Fraud Disclosure Terms document and route it for review.

01

Collect facts: Gather IDs, transaction logs, and witness contact information.
02

Fill form: Complete required fields and attach supporting documents.
03

Authenticate signer: Choose appropriate signer verification (email, SMS, ID check).
04

Submit: Send to compliance, retain a signed copy with audit trail.

Typical electronic workflow for a fraud disclosure

This outlines a common e-submission flow so teams can standardize intake, authentication, and archival steps.

Upload Document: Upload the template and attach evidence files.
Place Fields: Add signature, date, and text fields where required.
Authenticate Signer: Use email link, SMS OTP, or stronger ID proofing as needed.
Archive & Audit: Store the signed record with a timestamped audit trail.

Common configuration options for online completion

Configure these workflow elements to match your verification, routing, and retention policies when deploying the form electronically.

Field	Configuration
Authentication Method	Email link, SMS OTP, or knowledge-based checks
Routing Workflow	Sequential routing to compliance and legal reviewers
Retention Setting	Automated retention per policy (e.g., 6 years)
Audit Trail	Enable IP, timestamp, and action logging

Platform and file requirements for reliable eSubmission

Choose a platform that records evidence of consent, supports export to standard formats, and retains an auditable history for compliance reviews.

Integrations: Salesforce, NetSuite, Microsoft 365, Google Workspace
File Formats: PDF, DOCX, and HTML are commonly supported
Authentication: Email, SMS OTP, or advanced ID proofing

Timelines to observe after detecting suspected fraud

Prompt handling improves investigation quality and preserves rights; adjust internal timelines based on industry rules and regulator expectations.

Immediate Reporting:

Report internally within 24–72 hours of discovery.

Law Enforcement Referral:

Refer promptly if criminal conduct is suspected.

Insurance Notification:

Notify insurer within contract timeframes; often 30–90 days.

Regulatory Filings:

File required reports per agency timelines (varies).

Record Retention:

Preserve originals and attachments per retention schedule.

Key milestones from disclosure to closure

Track these sequential stages to show timely handling and create a defensible audit trail throughout the matter lifecycle.

01

Discovery

Initial identification and preliminary fact-gathering.

02

Internal Review

Compliance assesses risk and determines next steps.

03

External Reporting

Notify insurers, regulators, or law enforcement as required.

04

Retention & Closure

Archive records and document final disposition.

Common mistakes to avoid when preparing disclosures

Submitting incomplete incident descriptions or missing dates, which hinders investigators and can make evidence unusable.
Attaching unlabelled files or screenshots without context, forcing reviewers to guess the relevance of each item.
Using imprecise identifiers (e.g., last four digits only) that prevent accurate matching to accounts or transactions.
Failing to verify signer identity, increasing the risk that statements will be challenged or rejected.

Potential risks and penalties of incorrect or late disclosures

Regulatory Fines: Civil penalties from regulators

Criminal Exposure: Possible charges for deliberate concealment

Civil Liability: Lawsuits by harmed parties

Evidence Loss: Delayed action can degrade key proof

Tax Penalties: IRS penalties may apply for reporting errors

Reputational Harm: Customer trust and brand damage

Security and compliance considerations for electronic disclosures

Transport Encryption: TLS 1.2/1.3 in transit

Data at Rest: AES-256 encrypted storage

Audit Trail: Timestamped action logs and IP addresses

Certifications: SOC 2 Type II and ISO 27001 available

HIPAA Support: BAA required for PHI handling

21 CFR Part 11: Controls available for regulated records

eSignature vendor comparison — pricing and key features

Basic pricing and feature distinctions for commonly used eSignature providers. signNow is listed first by convention; compare feature fit and compliance support for your needs.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day trial	Varies	Varies	Varies	Varies
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No
Envelope Cap	No cap	100 envelopes/user/year	Varies	Varies	Varies

Frequently asked questions about Fraud Disclosure Terms

Answers to common questions about electronic signing, authentication, retention, and what to include when completing a Fraud Disclosure Terms document.

Need help? Contact support

Can this form be signed electronically?
Yes. Electronic signatures are generally enforceable under the ESIGN Act (15 U.S.C. §7001) and state UETA statutes so long as the signer demonstrates intent, consents to an electronic record, attribution is established, and a reproducible record is retained.
What authentication is recommended?
Use a level of signer authentication that matches the risk: email or SMS for low-risk disclosures, and ID credential analysis, KBA, or video verification for high-risk or regulatory matters.
How should I handle disclosures with PHI?
When disclosures include protected health information, ensure a Business Associate Agreement (BAA) is in place, follow HIPAA privacy requirements, and retain records for six years per 45 CFR §164.530(j).
What attachments are most useful?
Include transaction logs, redacted account numbers, screenshots with timestamps, correspondence, and witness contact details; clearly reference attachments in the incident description for context.
Who should sign the disclosure?
The person with firsthand knowledge should sign. If legal counsel or a corporate officer must attest, ensure signatory authority is documented in the file and recorded in routing logs.
How can a disclosure be amended or revoked?
Amendments should be submitted as clearly labeled supplemental disclosures with dates and signatures. Revocation is handled per organizational policy; retain both the original and any revocation for the record.

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