Get Written Statement Under Penalty Of Perjury For Ach Debits

This guide will help you successfully complete the Written Statement Under Penalty Of Perjury For ACH Debits form online. By following these instructions, you will be able to provide a clear and accurate statement regarding unauthorized or improper ACH debits to your account.

Follow the steps to fill out the form correctly.

1. Use the ‘Get Form’ button to access the form online and open it in the document editor.
2. Begin by filling in your account holder’s name in the designated field. Ensure your name is spelled correctly as it appears on your bank account.
3. Next, indicate the name of the financial institution where the ACH debit entry was charged. This should match the institution from which the funds were withdrawn.
4. Enter your account number associated with the ACH debit entry. Double-check for accuracy as this verifies your identity and account ownership.
5. Write the date when the ACH debit entry was charged. This is crucial for establishing the timeline of the transaction.
6. Fill in the amount of the unauthorized or improper ACH debit transaction. Make sure the amount reflects the exact figure that was debited from your account.
7. Proceed to Section 1 or Section 2 as applicable, checking the relevant boxes and providing any additional details regarding the unauthorized transaction or improper entries.
8. If applicable, describe your authorization status regarding the company that initiated the debit entry. Provide specific details about your authorization or revocation.
9. Include a declaration confirming that the debit transaction was not initiated fraudulently by you or anyone acting with you. This is important for legal accountability.
10. Date the document and add your signature in the designated signature area. This serves as a formal affirmation of the information provided.
11. Once completed, review the entire form to check for any missing information or errors before saving your changes.
12. After confirming accuracy, save the document to your device, or utilize printing or sharing options as required for submission.

Complete your Written Statement Under Penalty Of Perjury For ACH Debits online today.