SWORN STATEMENT
UNKNOWN CHARGE(S) IN CHECKING/CURRENT/CREDIT CARD ACCOUNT.
(Remember to accompany this sworn statement with a copy of your identity card)
I _______________________________________________________________(indicate names and
full surname), identity card No. ___________________, residing at
____________, in accordance
to article 4 of Law No. 20.009, I declare under oath that I have not granted my authorization nor
consent for the following charge(s) to be made to my account
current/checking account no. _______________; and/or credit card no. _______________________
which were carried out by third parties without my consent or authorization and in a manner
fraudulent.
Date of Movement Detail Amount Recipient or
Transaction Electronic Funds Transfer claimed $ commerce
(TEF/debit in current account/debit in credit card)
Gloss
Next, relate how the events occurred:
Please indicate: How did you notice the charges, mention if you keep the card or security device in your
power, as he proceeded upon realizing these charges.
Additionally, I declare that I am aware that according to article 4 of law 20.009, for the
cancellation of the charges or the refund of the funds corresponding to the claimed charges,
I will have to present to the Bank the evidence of the report for the acts constituting the crime of
fraud, before at least one of the following agencies: Public Ministry, officials of
Carabineros of Chile, the Investigative Police or before any competent court
criminal within a period of 30 consecutive days counted from the notice or claim. Failing to do so
within the indicated period, it will be understood that I retract the claim solely by the ministry of the law
not proceeding with the cancellation of charges or the refund of funds.
I also declare that I am aware that this sworn declaration may be used by
Bank of Chile for the exercise of civil and criminal actions that may proceed, also with full
knowledge of Article 7 of Law No. 20,009, which punishes with custodial sentences
who maliciously obtains for himself or for a third party the undue cancellation of the charges or the
reimbursement of funds referred to in Article 5 of Law 20.009, by providing data or
false antecedentes in this sworn statement, falsely denying one or more
transactions with payment methods of its ownership, simulating the existence of non-transactions
authorized, intentionally provoking them, or presenting them to the sender as having occurred by
Causes or in circumstances different from the true ones. For my part, I declare that I know Article 210.
of the Penal Code which provides that anyone who perjures or gives false testimony before authority or its agents
testimony in matters that are not contentious, will suffer the penalties of minor imprisonment in its degrees
minimum to medium and a fine of six to ten monthly tax units.
In _______________________, a_________of_______________of__________________
(Client's signature)