The sworn statement form required by §35.595(b)(2), Business & Commerce Code, must include:

1. (1) a notice, at the top of the first page, that provides that:

   1. (A) the customer must file a police report regarding an offense under §32.51, Penal Code; and

   2. (B) the customer must return the completed sworn statement with either:

      1. (i) the incident or case number of the police report; or
      2. (ii) a copy of the police report.

2. (2) blanks for the customer to provide:

   1. (A) customer's name, address, phone number, date of birth;

   2. (B) the number and the issuing governmental entity's name for the customer's:

      1. (i) driver's license or state issued identification card; or
      2. (ii) if the customer does not have a driver's license or state issued identification card, other government-issued identification.
   3. (C) the account number of any account compromised by the alleged offense and closed in response to the alleged offense;
   4. (D) routing number for the financial institution where the account was closed;
   5. (E) numbers or the range of numbers of any checks that have been lost, stolen, or compromised, if any;
   6. (F) the incident or case number of the police report; and
   7. (G) a signature before a notary public.

Source Note:The provisions of this §35.54 adopted to be effective January 3, 2008, 32 TexReg 9940.