#F4F5F7

Sample

FIRST-PARTY TRUST AFFIDAVIT

Note: A cardholder may complete and sign this First-Party Trust Cardholder Affidavit as one of
the
alternatives of supporting documentation with respect to the First-Party Trust Program.

Page 1 to be completed by the issuing institution and sent to the cardholder.

Filing Cardholder Information

Contact Name (optional): Carson Wentz Date: 09/26/2024

Company or Institution: __________________

Contact Email (optional):

Transaction Amount:

Transaction Date:

Merchant Name:

Acquirer Reference Data or Switch Serial Number:

Page 2 to be completed and signed by the cardholder before a notary public.

I, __________________ [Your Name], hereby attest that I did not authorize the
transaction dated ______________________ [Transaction Date] for ___________________ [Transaction
Amount] with ___________________ [Recipient/Business Name].
This transaction does not align with my financial activities, and I declare it to be
unauthorized.

Affiant/Cardholder Signature: ___________________

Affiant/Cardholder Name: ___________________

Date: ___________________

State of _______________

County of ______________

Sworn and subscribed before me, the undersigned authority, on the ____ day of ____, 20____,
by ______________________________, who is personally known to me or produced the following
identification: ____________________________.

Notary Public: ____________________
My commission expires: _____________

Description	The First-Party Trust Affidavit is required to pursue recovery when a 5002 chargeback is received as a part of Mastercard’s First-Party Trust program. The affidavit is included with the First-Party Additional Information letter as an attachment/enclosure.
Applies To	Mastercard Fraud
Category	Enclosure
Preview

First-Party Trust Affidavit

Related