Date (MM/DD/YY)
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© 2018 Navy Federal NFCU 27 (5-18)
Please return the completed form to Navy Federal Credit Union, or
P.O. Box 2464, Merrield, VA 22116-2464 or fax to 703-206-4085.
Security Appeal Form
This form should not be used to initiate the notification to Navy Federal Credit Union of fraud that has taken place. This form
should not be used to initiate an appeal of a fraud claim relating to a debit or credit card. Please provide supporting documentation with this
form to assist in the evaluation of a security action on your account(s). Please read each category in its entirety and ensure you have provided
all requested information. Allow 15 business days for your appeal to be reviewed.
A. Please complete each item in this section. (Required Information)
B. Please check and complete the category that best describes your appeal. (Required Information)
I am attempting to appeal an account restriction.
I am attempting to appeal Navy Federal’s decision to deny my membership application.
I am attempting to overturn the outcome of a fraud claim that I submitted previously.
I have attempted to correct the account issue(s) that may have led to the account restriction. (Required)
I am attaching my government-issued photo ID and proof of address documents. (Required by Section 326 of the USA PATRIOT Act)
I have new information that was not previously disclosed by me during the investigation. (Required)
I certify to the best of my knowledge and belief that all the information on this form is true, correct, complete, and made in good faith. I also understand that this
information may be provided to federal, state, and local law enforcement agencies for such action within 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.
Please describe your attempt to correct the account issue(s). (Use additional space on page 2 if needed.)
Please describe discrepancies with your submitted documents, if applicable. (Use additional space on page 2 if needed.)
Please describe the additional information that you have that may overturn our decision. (Use additional space on page 2 if needed.)
Name: First MI Last Suffix Access No.
Address: Street City State Zip Code Account No.
Best Contact No.
Application ID (If New Membership)
Date (MM/DD/YY)
Please provide any documentation you have relating to this appeal that may assist in the evaluation process (e.g., police report, original forged document(s),
government-issued photo ID, proof of address).
C. Use this section to provide any additional information.