*If your Member Number is less than 6 digits please use leading zeros, ex. 001234.

I declare that my card, described above, was:

If card(s) still in possession, did you respond to a phishing attempt?

Yes   No

Was law enforcement notified?
Yes   No

• I am completing this “written confirmation” for the purpose of establishing the fraudulent use of my Debit card.
• I did not give, sell, or trade my card to anyone, nor did I give anyone permission to use my card.
• I have no knowledge that my spouse or minor child(ren) made any transaction(s) on or after the date of the first fraudulent transaction indicated below.
• I did not receive any benefit from the unauthorized use of my Debit card.
• I did not use my card, nor authorize the use of my card by anyone else, after I discovered the unauthorized use of my card.
• I have examined all of the unauthorized transactions, and in each instance, I did not originate the transaction, nor authorize it.
• Further, I did not receive proceeds or benefits from any of those transactions.

I give my consent to Sun East Federal Credit Union to release any information regarding my card and/or card account to any local, state, and/or federal law enforcement agency so that the information can, if necessary, be used in the investigation and/or prosecution of any person(s) who may be responsible for fraud involving my card and/or card account. I swear this “Written Confirmation” is true and understand that making a false statement is sworn statement is subject to federal and/or state statutes and may be punishable by fines and/or imprisonment.