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Under penalty of perjury statement example 2026
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- Click ‘Get Form’ to open the under penalty of perjury statement example in the editor.
- Begin by filling in the state and county where you reside at the top of the form. This establishes your jurisdiction.
- Enter your name as the account holder, followed by the financial institution's name that issued the ACH debit notification.
- Provide your account number and the date of the unauthorized or improper transaction, along with the amount charged.
- Complete either Section 1 or Section 2 based on whether you are disputing an unauthorized consumer entry or an improper entry. Check the appropriate boxes and fill in any required details.
- Sign and date the form at the bottom, certifying that all information provided is true and correct under penalty of perjury.
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