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Sample

STATEMENT OF FRAUD

RE: Case 2407030001C for account ending in 1234

I, Mr. Steve Rogers, hereby state that the above-referenced card was (select one):

____ Lost / Stolen
____ Never received in the mail
____ Used without my authorization, but still in my possession

I have not used the card account described above for the transaction(s) listen below. I have not authorized anyone else to use or have possession of the card account described above. I did not, and will not, receive any goods, services or other benefit as a result of the transaction(s) listed below.

The signatures or other forms of authorization appearing on any of the sales drafts, ATM transactions, telephone/mail orders, or applications for the transaction(s) listen below, are and will be forgeries.

628d8775-9066-4036-9423-03811775e815Sample2eJyLjgUAARUAuQ==false

____ I have no knowledge of the identity or whereabouts of the person(s) responsible for the transactions listed above, OR:

____ I can identify the suspect as:

Name:		Phone Number:
Address:
City, State:

Please provide any additional information you believe may be helpful in our investigation (you may attach additional pages, if needed):

__________________________________________________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________________________________________________

I certify that, to the best of my knowledge and belief, all the information on this statement is true, correct, complete and made in good faith. I understand that this statement and the information it contains may be made available to federal, state, and/or local law enforcement agencies for such action within their jurisdiction as they deem appropriate.

Signature: _________________________________________________ Date: ___________________

Description	The statement of fraud is sent in certain fraud disputes where specific documentation is required to support the claim. It is typically included with the confirmation letter as an enclosure but can also be sent manually from the Communication Hub. When it is sent manually, it will include a cover letter.
Applies To	Card
Category	Enclosure
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Statement of Fraud

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