Letter Form 116 Collection Agencies and Merchants Letter

CLAIM OF FRAUDLENT ACCOUNT- COLLECTION AGENCY

Name:
Address:
City/State/Zip:
Phone Number:

Date:
 

RE:        Credit Card or Bank Acct #________________________________
            Check #_______________________________________________

To Whom it may Concern,

This letter is a notice to inform you that on or about ____/____/______ (date), the following occurred...

_____ Checks numbered ______ to______ for _________________ (bank name_________________, acct #________________________) were stolen.

Be advised that this account was closed on ____/_____/______ (date) by the bank upon my request.

_____ Checks numbered ____, _____ have been fraudulently created by another person using my name and address as the account holder

_____ A credit card was opened without my authorization or knowledge, using my name, social security number and other personal data. Card #______________

_____   Credit card # ________________ was stolen and then used by the thief. Be advised that this account was closed on ____/_____/______ (date) when I directly called the credit card company and told them of the theft.

_____ Other (explain)
          _____________________________________________________________

These checks/credit cards are now or were being fraudulently used to obtain goods and services from merchants. You are officially being told that this is a case of identity theft or financial fraud and that an investigation is required at this time.

Please be advised that appropriate agencies and companies have been notified. You are free to contact any of these agencies to verify this information. If available, a copy of the police report will be attached to this letter.

Name of police department fraud was reported to:__________________________

Contact person and phone number ______________________________________

Bank: _____________________________________________________________

Contact person and phone number ______________________________________

Credit Card company _______________________________________________

Contact person and phone number ______________________________________

I have also notified the three major credit reporting agencies, Equifax, Experian and TransUnion, placed a fraud alert on my credit report and notified them of possible fraudulent activity. Where appropriate, I have also notified the following check verification companies: __________________________________________

Please advise your client or the assignor of this criminal activity and notify them to not reassign this account to another agency.   So far these criminals have stolen approximately $________ in checks or credit charges in my name.

Now that you have been notified in writing about the fraud-- Be advised that reporting these items to the credit agencies as collection items or continuing to pursue these debts from me prior to an investigation would be considered a violation of the state and federal level Fair Debt Collection Practices Act and the Fair Credit Reporting Act.

I hereby request photocopies of any applications, application information or transaction information you may have on this account. (Required by law in CA and WA, federal law-FACTA effective June 2, 2004)  

Once you have finished your investigation and have cleared this fraudulent account from my identity, I formally request a Letter of Clearance for my records.

I declare under penalty of perjury that this declaration is true and correct to the best of my knowledge. Knowingly submitting false information on this affidavit could subject me to criminal prosecution for perjury.

Sincerely,

__________________________________________             _________________
Name                                                                                        Date

Non-relative witness to signature:   (Print Name)____________________________

Witness signature________________________________     Date______________

Witness phone number____________________