Form Fr005 PDF Details

In an era where online and electronic transactions have become a staple in our financial activities, the safeguarding of personal and financial information has never been more critical. It is within this context that the FR005 form gains its significance. Designed as a tool for combatting unauthorized access and fraudulent activities, the FR005 form serves as an affidavit for individuals who find themselves victims of illegal online, bill pay, telephone, or wire transactions. This document not only facilitates individuals in declaring unauthorized activities but also necessitates the inclusion of a current police report case number, ensuring that the affidavit is backed by an official investigation. The meticulous design of this form requires detailed information about the member, the unauthorized transactions, and any known details of the perpetrator, alongside a notarized signature to validate the claim. Significantly, the form underscores the indispensable cooperation between victims, financial institutions, and law enforcement, allowing for a coordinated response to fraud. By submitting the FR005 form, victims give their consent for their financial institution to share account details with relevant authorities, a critical step toward the investigation and potential prosecution of fraudulent activities. Here, the document underscores a twofold purpose: aiding individuals in reclaiming financial integrity while simultaneously contributing to broader efforts against financial crime.

QuestionAnswer
Form NameForm Fr005
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesdefraud, fraudulent forms, wire fraud form, social security fraudulent activity forms

Form Preview Example

AFFIDAVIT

FRAUDULENT USE OF ON LINE ACCESS, BILL PAY, TELEPHONE AND WIRE SERVICES

This form should be used for all unauthorized online, bill pay, telephone or wire activity. This form must be signed and notarized; and requires a case number from a current police report filed against the unauthorized activity. If a further detailed explanation is necessary, please provide these on a separate sheet.

OnLine Access

Bill Pay

Telephone

Wire Services

MEMBER INFORMATION

I make this affidavit for the purpose of establishing the fraudulent use of my account. I did not give, sell, or trade my OnLine Access code or Telephone Password to anyone nor did I give anyone permission to use my account. I have no knowledge that my spouse or minor children made any transaction(s) on or after the date of the first fraudulent transaction(s) indicated below. I did not receive any benefit from the unauthorized use of my account.

Member Name

 

 

 

 

 

Member Number

 

 

 

 

 

 

 

 

 

Daytime Phone

 

 

 

 

 

Evening Phone

 

 

 

 

Cell Phone #

 

 

Mailing Address

 

 

 

 

 

 

 

 

City

 

 

 

 

 

State

 

Zip

Date Loss

 

 

Date Loss Reported to Credit Union

 

 

Date of First Fraudulent Transaction

 

 

Discovered

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LIST UNAUTHORIZED TRANSACTIONS BELOW:

 

 

Date

 

Recipient Name/Member #

 

Amount

 

 

Date

 

 

Recipient Name/Member #

 

Amount

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name and Address of Unauthorized User (if known)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Police Report Details (Anchorage Police Department: Records Department 786-8600)

 

 

Case #:

 

 

(This is a requirement, the claim will not be processed until a case number is provided)

 

 

 

 

 

 

 

 

 

 

SIGNATURES

I give my consent to the credit union to release any information regarding my 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 account. Further, I understand I may be required to comply with a court order or subpoena to give testimony. I swear this affidavit is true and understand that making a false sworn statement is subject to federal and/or state statutes and may be punishable by fines and/or by imprisonment.

NOTICE: Any person who knowingly and with intent to injure, defraud or deceive any insurance company, submits a statement of claim containing any false, incomplete or misleading information commits a crime.

State of

 

 

Judicial District

 

 

 

Subscribed and sworn to before me this

 

 

 

day of

 

Notary Public

 

 

 

 

 

 

 

 

 

Member’s Signature

 

 

 

 

Joint Member’s Signature

 

 

Prepared by Operator #

Fax Completed Form to Accounting

Page 1 of 2

FR005 Rev.8-11

Attachment A

Member #

 

 

 

 

Date

Recipient Name/ Member #

 

Dollar Amount

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature

Date

Fax Completed Form to Accounting

Page 2 of 2

FR005 Rev.8-11

How to Edit Form Fr005 Online for Free

You are able to fill in fraudulent activity without difficulty by using our online tool for PDF editing. To make our tool better and more convenient to use, we continuously come up with new features, considering suggestions from our users. All it takes is a couple of easy steps:

Step 1: Click on the "Get Form" button in the top section of this webpage to open our tool.

Step 2: This editor allows you to modify PDF files in a variety of ways. Modify it by adding your own text, correct what's already in the file, and put in a signature - all at your fingertips!

This PDF form requires specific details; in order to guarantee consistency, you should take heed of the suggestions listed below:

1. Complete your fraudulent activity with a selection of major fields. Note all the important information and make certain there's nothing missed!

The way to fill out social security fraudulent activity forms step 1

2. Once your current task is complete, take the next step – fill out all of these fields - Members Signature, Fax Completed Form to Accounting, Joint Members Signature, Prepared by Operator, and Page of FR Rev with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

Stage # 2 for filling out social security fraudulent activity forms

3. Completing Attachment A, Member, Recipient Name Member, Dollar Amount, and Date is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

Recipient Name Member, Attachment A, and Dollar Amount in social security fraudulent activity forms

People frequently get some points incorrect when filling out Recipient Name Member in this section. Be sure you read twice what you enter here.

4. This next section requires some additional information. Ensure you complete all the necessary fields - Signature, and Date - to proceed further in your process!

Stage no. 4 in submitting social security fraudulent activity forms

Step 3: Revise the information you've entered into the blanks and then click the "Done" button. Create a free trial plan at FormsPal and obtain immediate access to fraudulent activity - downloadable, emailable, and editable from your personal account. When using FormsPal, you can easily fill out documents without worrying about data leaks or entries getting shared. Our secure platform helps to ensure that your personal data is kept safe.

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