Fraud Reporting Form What is your name?* First Last What is your membership number?* Where can I find this?What is your email address?* What transaction(s) you wish to report as fraudulent?*DateAmountPayee Information Please list the transactions which are being reported as unauthorised or disputedWere any of these transactions made by you or anyone authorised to use your account? Yes No Did you share any security details (such as a password or text message) with another person to enable them to perform the transaction(s)?* Yes No What security details did you share with them?* Online Banking Login Details Card Details Card PIN Text Message Security Code Answers to Security Questions Personal Details (e.g. Date of Birth, Phone Number) Telephone Password Other Tick all that applyDid you have any direct contact with this person?* Yes No What direct contact did you have with this person?* Spoke to them by phone Communicated over email Met them in person None What other details did you share?* Have you received any goods or services as a result of any of these transactions? Yes No Do you believe these transactions were carried out by someone you know?* Yes No Relation of this person to you* Any other details you think are relevantTotal amount of fraudulent transactions: £ 0.00 Signature*Date MM slash DD slash YYYY Fraud Reporting Terms* You must call us as soon as you notice that an unauthorised payment has been made from your account. If this happens, we’ll immediately refund the amount of the unauthorised payment unless any of the following apply: you tell us more than 13 months after the payment was made; we can prove that you acted fraudulently; Please Note: If you’ve acted fraudulently you’ll be liable for all payments from your account. we can prove that the unauthorised payment was made because of your gross negligence; An example of gross negligence would be if you knowingly give your card and PIN number to someone else. we can prove that the unauthorised payment was made because the payment device was lost or stolen or we can show you failed to keep your security details safe. In this case, you’ll be liable for the unauthorised payment up to a maximum of £35, and we’ll reduce the refund by this amount. You are not liable for any unauthorised payment made remotely (for example, by telephone or the internet) and in some other circumstances, unless you have acted fraudulently or were grossly negligent. A payment is not unauthorised, and we will not refund it, if it was made by someone using a payment device or security details with your consent. I confirm that I read and agree to the rules of LMCUEmailThis field is for validation purposes and should be left unchanged.