Product: Credit card or prepaid card

Credit Union Written Statement of Forgery for Credit Card Please retum the completed form within 10 business days to Navy Federal Credit Union, XXXX XXXX XXXX, XXXX, VA XXXX. or, you can fax it to XXXX. 
The transactions identified below were not authorized or signed by me or by anyone acting upon my authority or with my consent or knowledge. I have not authorized anyone else, orally or in writing, nor have I given consent, nor do I have knowledge of implied consent, to use or have possession of this Navy Federal Credit Card. Neither l, nor any person ( s ) authorized to use my Navy Federal Credit Card, have received or will receive goods or services, or will otherwise benefit, directly or indirectly, from the transactions identified below. 
I believe that sales drafts, ATM transactions, telephone/mail orders, or applications bearing my purported signature, or the purported signature of person ( s ) authorized to use my Navy Federal Credit Card following the date reported above, are and will be forgeries.

The tansacion ( s ) were not made by anyone acting my authority or consent or identified by me nor upon with my knowledge. have no knowledge of the id -can identify the suspect as : Address Phone No. Security List of Fraudulent Transactions ( Required ) Please list all fraudulent charges in the space below to ensure that they I certify to the best of my knowledge and belief tiat all the information on this form is true, correct, complete, and rnade in good faith. I also understand that this information may be provided to federal, state, and local law enforcement agencies for such action widlin their jurisdiction as they deem appropriate. I understand that knowingly making any false or fraudulent statement or representation may constitute a violation of 18 U.S.C. or other federal, state, or local criminal statutes and may result in imposition of a fine, imprisonment, or both. 
Cardholder Sign re List Continues on Back XXXX XXXX Navy Fedal NFCu XXXX ( XXXX ) -ist of Fraudulent Transactions ( Continued ) XXXX XX/XX/XXXX XXXX XXXX XXXX XXXX XXXX XXXX XXXX XXXX XXXX XXXX ( XXXX XXXX XXXX XXXX NFCU XXXX ( XXXX ) XXXX XXXX XXXX XXXX XXXX XXXX Navy Federal XXXX XXXX XXXX XXXX XXXX Card MINIMUM PAYMENT DUE PAST DUE PAYMENT PAYMENT DUE DATE NEW BALANCE ACCOUNT NUMBER AMOUNT ENCLOSED XXXX XXXX XX/XX/XXXX XXXX xxx xxxx xxxx XXXX $ PLEASE INDICATE CHANGE OF ADDRESS ON REVERSE. 
PLEASE MAKE CHECK PAYABLE AND MAIL TO : NAVY FEDERAL XXXX XXXX XXXX XXXX. XXXX  XXXX XXXX XXXX XXXX XXXX VA XXXX XXXX XXXX FL XXXX XXXX SUMMARY OF ACCOUNT ACTIVITY PAYMENT INFORMATION Previous Balance {$8500.00} Payments - {$170.00} Other Credits * {$0.00} Purchases + {$1.00} {$26.00} Cash Advances + {$200.00} Fees Charged Interest Cha ed + {$93.00} New Minimum-payment Duo {$210.00}. 
Payment Due Date XX/XX/XXXX Late Payment Waming : lf we do not receive youd @ minimUm payment by the date listed above, you may have to pay a- $ XXXX late fee and your APRSOaybe increased up to the Penalty APR of 18.00 %. 
Minimum Payment Warning : If you make only the minimum payment each period, you will pay more in interest and it will tak & you longer to ay off your balance. For example : Balance {$10000.00} Past Due Amount {$0.00} Credit Limit {$17.00} ; XXXX Available Credit $ XXXX Cash Limit {$5.00} ; XXXX Available Cash {$4.00} ; XXXX Statement Closing Date XX/XX/XXXX Da s in Billin cle30 Ifyou make no additional charges using this card and each rnonth you pay. You will pay off the balance shown on this statement in about.. And you will end up paying an estimated total of ... 

minimum payment years {$20000.00} Navy Federal More Rewards American Express @ Card Rewards Details Rewards for XX/XX/XXXX Qualified Spend Rewards PoinE Groceries {$8.00} @ 3x 27 Gas Stations {$210.00} @ 3x 636 Restaurants {$0.00} @ 2x Other Eligible Purchases {$1700.00} XXXX Total This Period {$1900.00} XXXX Total Reward Year to Date {$10000.00} XXXX CREDIT CARD CHANGE OF ADDRESS NFCU ACCOUNT NO. CARD ACCOUNT NO. 
RANK/RATE NAME ( FIRST Ml SUFFIX ) NEW ADDRESS CITY STATE ZIP CODE APPLICANT OR CO-APPLICANT SIGNATURE THIS ADDRESS CHANGE IS APPLICABLETO : THIS CARD ONLY ALL APPLICANT 'S NFCU ACCOUNTS C ] JOINT NFCU SAVINGS IS A JOINT ACCOUNT HOMETELEPHONE WORKTELEPHONE