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Description Excerpt The Written Statement of Unauthorized Debit is required to support ACH claims. It is typically included with the confirmation letter as an attachment/enclosure, but can also be sent manually from the Communication Hub. When it is sent manually, it will include a cover letter.  The statement section of the form will be pre-selected, based on the answers provided during intake. Applies To ACH Relates To Stagil incoming links macro PreviewPreview Image Added

Cover Letter Content

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Additional information is required in order for us to complete our investigation. Please complete, sign, and return the attached Written Statement of Unauthorized Debit form and return to the address below within 10 business days.

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Cover Letter Sample

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Statement Content

WRITTEN STATEMENT OF UNAUTHORIZED DEBIT (ACH)

I. Account Information

II. Transaction Information

III. Statement

I (the undersigned) hereby attest that (i) I have reviewed the circumstances of the above electronic (ACH) debit(s) to my account, (ii) the debit(s) were not
authorized, and (iii) the following, to the best of my ability to identify, is the reason for that conclusion:

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WRITTEN STATEMENT OF UNAUTHORIZED DEBIT (ACH)

I. Account Information

II. Transaction Information

III. Statement

I (the undersigned) hereby attest that (i) I have reviewed the circumstances of the above electronic (ACH) debit(s) to my account, (ii) the debit(s) were not
authorized, and (iii) the following, to the best of my ability to identify, is the reason for that conclusion:

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