You can open the Adverse Action Notice Template in multiple formats, including PDF, Word, and Google Docs.
Adverse Action Notice Template Printable | Editable FormSample
Examples
[Name of the Consumer]
[Consumer’s Address]
[Consumer’s City, State, Zip Code]
[Date of Notice]
Notice of Adverse Action
This notice is to inform you that an adverse action has been taken regarding your application for [Specify the application type, e.g., credit, rental, employment] due to information obtained from [Name of the Consumer Reporting Agency or other source].
The adverse action was based on the following information:
1. [Reason 1 related to credit history or background check]
2. [Reason 2 if applicable]
3. [Additional reasons if applicable]
You have the right to obtain a free copy of your credit report from the reporting agency within 60 days of this notice. Additionally, you have the right to dispute the accuracy or completeness of any information in your report. For assistance, please contact:
[Consumer Reporting Agency Name]
[Agency Address]
[Agency Phone Number]
If you wish to discuss this decision or the information that led to it, please contact us at:
[Your Company Name]
[Your Company Address]
[Your Company Phone Number]
[Your Name]
[Your Position]
[Your Company Name]
[Name of the Consumer]
[Consumer’s Address]
[Consumer’s City, State, Zip Code]
[Date of Notice]
Notice of Adverse Action
This notice is provided as a formal notification that an adverse action has been taken against you concerning your application for [Specify the application type].
The reasons for the adverse action are as follows:
1. [Reason 1 related to credit score or background information]
2. [Reason 2 if applicable]
3. [Additional reasons if necessary]
You are entitled to receive a free copy of your credit report from the reporting agency within 60 days from the date of this notice. You also have the right to dispute any inaccuracies in your credit report. Please contact:
[Consumer Reporting Agency Name]
[Agency Address]
[Agency Phone Number]
Should you require further clarification regarding this adverse action, please reach out to:
[Your Company Name]
[Your Company Address]
[Your Company Phone Number]
[Your Name]
[Your Position]
[Your Company Name]
Format
Please complete the form below to create the Adverse Action Notice Template. All fields must be filled out to ensure compliance with applicable laws and regulations. We provide examples to guide you through each step. Adverse Action Notice Template 1. Consumer Information 2. Company Information 3. Reason for Adverse Action 4. Credit Reporting Agency Information 5. Consumer Rights 6. Additional Information 7. Notification Date 8. Signature and Declaration
PDF
WORD
Google Docs
Adverse Action Notice Template Printable | Editable FormPrintable
