Follow the steps to complete the form successfully.

1. Press the ‘Get Form’ button to access the document and open it in your editing tool.
2. Begin by entering your name in the designated field. This is required for identifying the person filing the declaration.
3. Input your account number in the provided space to link the declaration to your specific account.
4. If applicable, include the joint account holder's name to reflect any shared responsibilities.
5. Provide the ATM card number in the corresponding field to identify the card associated with the unauthorized transaction.
6. Fill in your phone number, ensuring that it is accurate so that you can be contacted if further information is needed.
7. Carefully list the transaction dates where unauthorized use occurred. Each date should be entered on a new line.
8. Record the transaction amounts in the section specified, ensuring that each amount corresponds to the correct transaction date.
9. Indicate the type of transaction for each entry (e.g., withdrawal, transfer) in the appropriate field.
10. Note the location of the ATMs where the unauthorized transactions took place, if known.
11. Complete the declaration about possession of the card during the transactions by checking the appropriate box.
12. Answer whether the PIN was written on the card or any surrounding document; check 'Yes' or 'No' as needed.
13. Detail when the ATM card was lost or stolen and the date this was reported to Certified Federal.
14. Provide a brief explanation of how the loss or theft occurred in the space provided.
15. If applicable, give the name and address of any person to whom you previously allowed access to the card.
16. Respond to the questions about your knowledge of the transactions and persons involved, marking 'Yes' or 'No' accordingly.
17. If you've engaged with an email requesting card verification, indicate your response.
18. Summarize any additional information you have regarding the transactions or individuals involved in the situation.
19. Finally, append your signature and the joint account holder's signature in the designated areas. Date the form before submission.
20. After completing the form, save your edited changes. You can then download, print, or share the completed form as needed.

Complete your Certified Federal ATM Declaration of Unauthorized Use online today and ensure your report is submitted promptly.