The following people had access to my computer or smartphone during the time periods in which the transactions listed above took place: Stock Symbol Number of Shares Dollar Amount Additional transaction details may be listed on a separate sheet and attached.
Yes No I am aware that my computer has been infected with malware viruses, trojans, etc. The following is a list of mallard I know my computer to be infected with: The following is a list of malware I know my computer to be infected with: Date of Transaction Description of Transaction purchase, sale, transfer, etc.
I have filed a police report: If you are unable to complete the af? I agree with the above I disagree with the above I did not knowingly share with any other person my ShareBuilder username, logon ID, password, or other related con?
I did not authorize the following transactions in my Account: Additional transaction details may be listed on a separate sheet and attached. Page 2 of 4 Additional information Please check Yes or No to the below questions and provide any additional information needed: Capital One ShareBuilder, Inc.
If charges are brought against the person s who has committed this fraud, I am willing to cooperate fully with law enforcement officials, including assisting in prosecution and authorizing the release of information.
Date of Transaction Description of Transaction purchase, sale, transfer, etc. Delays on your part could slow the investigation.
I did not receive any money, goods, or services nor did I bene? Change your password for your ShareBuilder and all other? No I have filed a police report with the law enforcement agency named below: I agree with the above I disagree with the above I have no direct knowledge of who may have entered these transactions.
Additional information may be listed on a separate sheet and attached. I did not receive any money, goods, or services nor did I benefit in any other way as a result of these unauthorized transactions.affidavit and to treat and consider the aforementioned withdrawal(s) as unauthorized.
() The transaction was unauthorized.* No one authorized to use this account signed for or participated in the transaction.
* At the time of the transaction, please indicate status of card (check one). AFFIDAVIT OF UNAUTHORIZED USE Debit Card Credit Card 1.I affirm and state that I am: Name: _____ Mailing Address.
Affidavit - Fraudulent Use of a Debit Card Member Information I make this Affidavit for the purpose of establishing the fraudulent use of my METRO Federal CU card. I did not give, sell or trade my credit/debit I did not receive any benefit from the unauthorized use of my card(s).
Name Home Phone () Work Phone. Non-Disclosure Affidavit I hereby acknowledge that all information technology resources in Miami-Dade County’s possession may constitute or contain information or materials which the County has agreed to protect as proprietary from disclosure or unauthorized use and may also constitute or contain information or materials which Miami-Dade.
I make this affidavit for the purpose of establishing the fraudulent use of my ATM, Visa Debit Card, and/or PIN. I did not give, sell or trade my ATM, Visa Debit card or PIN to anyone that transacted the fraudulent debit(s) and/or deposit(s) listed. To continue with Submitting an Affidavit of Non-Use select the button below.
Submit Affidavit of Non-Use If you want to remove the Affidavit on Non-Use on your Vehicle, select the button below.Download