Fraud Penalties Acknowledgment Form
Please review and acknowledge your understanding of fraud-related penalties. Confirm your information and agreement to comply as required.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Organization or Department
*
Role or Position
*
I acknowledge that I have read and understand the penalties associated with fraudulent actions as described in the relevant policies.
*
I acknowledge and understand
I do not acknowledge
I confirm that all information provided in this form is true and accurate to the best of my knowledge.
*
I confirm
I do not confirm
If you have any additional comments or wish to disclose relevant information, please enter it here.
Date of Acknowledgment
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature (draw your signature to acknowledge)
*
Submit Acknowledgment
Submit Acknowledgment
Should be Empty: