Substitute Check Expedited Recredit Claim Form
Please complete, print, sign, and mail this form to:
Star One Credit Union
P.O. Box 3643
Sunnyvale CA 94088-3643
Making an Expedited Recredit Claim
If you have received a Substitute Check and demonstrate that the original check is necessary to show that you have suffered a loss, you can use this form to make a claim for a refund. If you use this procedure, you may receive up to $2,500 of your refund (plus dividends if your account earns dividends) within 10 business days after we received your claim and the remainder of your refund (plus dividends if your account earns dividends) not later that 45 calendar days that the Substitute Check was correctly posted to you account.
|Member's Name who either wrote or deposited the original check:|
|Check this box if the Substitute Check or a copy of the Substitute Check is being submitted with this form.|
If the Substitute Check or a copy of the Substitute Check is not being submitted with this form, please provide the following information:
|The check number:|
|The name of the person to whom the check was written:|
|The amount of the check: $|
|The date of the check:|
Amount of Loss
Estimate of the total amount of your loss (includes interest owed or fees paid): $
Description of the Loss
Describe why you have suffered a loss:
|The Substitute check was improperly charged to the account|
|The Substitute Check was charged from your account more than once|
Need for Original Check
Explain why the Substitute check you received is insufficient to confirm that you suffered a loss:
|Information contained on the Substitute Check is illegible (for example, the amount)|
|Physical examination of the check is necessary (for example, to prove forgery) because:
400 characters maximum
You declare under penalties of perjury that the above information is true and correct.
You hereby revoke this expedited recredit claim and release Star One Credit Union from any liability with regard to the same.
|Received by (Operator ID and Initials):|
|Date Claim Received
(Postmark if received by mail)
|Date of Statement or
Date Substitute Check Made Available
Remember that Star One employees will never call you to verify or ask for your personal information.
Providing your personal information, such as card PINs, online banking credentials or one-time passcodes, to anyone may make you responsible for any fraudulent activity that happens on your Star One accounts.