Legal Fraud Alert Form

LEGAL FRAUD ALERT FORM

This Legal Fraud Alert Form is entered into by and between Consumer Name: (hereinafter "Consumer") and Recipient Name: (hereinafter "Recipient") on Effective Date: .

RECITALS

WHEREAS, Consumer has discovered or reasonably suspects that fraudulent activity has occurred involving the Consumer's personal identifying information or financial accounts, including but not limited to unauthorized use, account takeover, or false account creation; Incident Date: .

WHEREAS, Consumer seeks to notify Recipient and request immediate protective measures, preservation of records, and investigation by Recipient to prevent further loss and to assist in the resolution of fraudulent activity;

WHEREAS, Recipient acknowledges receipt of this written notice and agrees to take the actions described in this form in accordance with applicable law and the terms set forth below;

NOW, THEREFORE, in consideration of the mutual covenants contained herein, the parties agree as follows:

1. DEFINITIONS

For purposes of this form: (a) "Fraud" means unauthorized use of personal identifying information or access to financial or service accounts to obtain money, goods, services, or benefits; (b) "Investigation" means Recipient's good-faith review of accounts and records reasonably related to the alleged Fraud; and (c) "Preservation Period" means the period during which Recipient must safeguard records and data related to the alleged Fraud as set forth in Section 4.

2. STATEMENT OF FRAUD

Consumer hereby declares under penalty of perjury that the following description is true and correct to the best of Consumer's knowledge:

Type of suspected fraud (check all that apply):

Identity theft    Account takeover    Unauthorized transactions    New account creation without authorization    Other

3. ACTIONS REQUESTED OF RECIPIENT

Consumer requests that Recipient take the following actions without undue delay and in accordance with applicable law:

Close or freeze the affected account(s) listed below
Block further unauthorized transactions and access
Preserve all account records, logs, correspondence, and electronic data related to the alleged Fraud for the Preservation Period
Provide to Consumer, upon written request, copies of records reasonably necessary to investigate and prosecute the Fraud
Notify affiliated departments or third parties reasonably necessary to prevent further fraud

4. EVIDENCE AND ATTACHMENTS

Consumer may attach copies of supporting documentation. Recipient may request certified copies of official reports where required by law. Provide any available identifying or investigative references below:

5. INVESTIGATION AND RESPONSE PROCEDURES

Recipient shall commence a good-faith Investigation promptly upon receipt of this notice. Unless otherwise required by law, Recipient shall acknowledge receipt within business days and provide a substantive written response within calendar days describing actions taken, results of the Investigation, and any corrective measures.

6. CONFIDENTIALITY AND DATA HANDLING

Recipient agrees to treat all information received in the course of this Investigation as confidential to the extent permitted by law, to limit access to personnel with a legitimate need to know, and to handle personal data in accordance with Recipient's privacy obligations. Recipient will take reasonable measures to prevent unauthorized disclosure of Consumer's personal identifying information.

7. CERTIFICATION, FALSE STATEMENT WARNING, AND INDEMNIFICATION

Consumer certifies under penalty of perjury that the information provided herein is true and correct to the best of Consumer's knowledge and belief. Consumer acknowledges that knowingly submitting false information to obtain a benefit, to mislead a financial institution, or otherwise may subject Consumer to civil liability and criminal prosecution. Consumer shall indemnify and hold harmless Recipient for damages arising from any materially false statements made by Consumer.

8. NOTICES

All notices under this form shall be made in writing and delivered to the addresses provided below. Notice is effective upon receipt for hand delivery, domestic courier, or electronic transmission followed by a confirmatory copy by mail.

9. AMENDMENTS; WAIVER

Any amendment to this form must be in writing and signed by both parties to be effective. No waiver of any breach shall constitute a waiver of any other breach or of the same breach at another time unless expressly agreed in writing by the waiving party.

10. GOVERNING LAW

This form shall be governed by and construed in accordance with the laws of the state specified by the parties, without regard to its conflict of law principles. The parties submit to the exclusive jurisdiction of courts of competent jurisdiction located in that state for disputes arising under this form.

11. ENTIRE AGREEMENT; SEVERABILITY; COUNTERPARTS

This form constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior written or oral agreements. If any provision of this form is found to be invalid or unenforceable, the remaining provisions shall continue in full force and effect. This form may be executed in counterparts, each of which shall be deemed an original and all of which together constitute one instrument.

12. SIGNATURES

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