The FTC Identity Theft Affidavit form serves as a crucial tool for individuals aiming to report instances of identity theft to law enforcement, as well as to dispute unauthorized transactions or fraudulent accounts with credit bureaus and creditors. Designed to streamline the process of rectifying the consequences of identity theft, the form requires victims to detail their personal information, the nature of the fraud, and any known perpetrator's details. It underscores the importance of immediate actions such as placing fraud alerts on credit reports and closing compromised accounts. For those seeking to reclaim their financial integrity and personal security, completing and submitting this affidavit is a significant step forward. Click the button below to fill out the form.
In today’s digital age, identity theft has become a pervasive issue, affecting millions of individuals, compromising personal information, and leading to financial loss and damage to credit standings. Recognizing the gravity of this issue, the Federal Trade Commission (FTC) provides a substantial resource for victims through the Identity Theft Victim’s Complaint and Affidavit form. This comprehensive document serves as a critical tool for individuals to report instances of identity theft to law enforcement, and to dispute unauthorized transactions and inaccuracies with credit reporting agencies and creditors. Completing the form takes approximately 10 minutes, and it covers essential information including personal details, declarations about the identity theft, and specifics about the fraudulent activities. The form requires victims to detail their personal information both at the time of the fraud and presently, to provide a pathway for correcting inaccuracies in credit reports and resolving disputes with creditors. Importantly, it includes a section for filing a law enforcement report, which can be pivotal in getting the credit reporting agencies to quickly block fraudulent information from appearing on a victim’s credit report. Victims are urged first to place a fraud alert on their credit reports and review them for signs of fraud, as well as to close any compromised or fraudulently opened accounts, before filling out and submitting this affidavit. The FTC also emphasizes the importance of protecting the affidavit’s sensitive information by only providing Social Security numbers when necessary and directly to legitimate entities. The FTC Identity Theft Affidavit thus stands as a vital step for victims to reclaim their financial integrity and to assist in the broader fight against identity theft.
Average time to complete: 10 minutes
Identity Theft Victim’s Complaint and Affidavit
A voluntary form for filing a report with law enforcement, and disputes with credit reporting agencies and creditors about identity theft-related problems. Visit ftc.gov/idtheft to use a secure online version that you can print for your records.
Before completing this form:
1.Place a fraud alert on your credit reports, and review the reports for signs of fraud.
2.Close the accounts that you know, or believe, have been tampered with or opened fraudulently.
About You (the victim)
Now
(1)My full legal name: ________________________________________________
First
Middle
Last
Suffix
(2)My date of birth: __________________
mm/dd/yyyy
(3)My Social Security number: ________-______-__________
(4)
My driver’s license: _________
___________________
State
Number
(5)My current street address:
____________________________________________________________________________
Number & Street NameApartment, Suite, etc.
_______________________________________________________________
City
Zip Code
Country
(6)I have lived at this address since ____________________
mm/yyyy
(7)My daytime phone: (____)___________________
My evening phone: (____)___________________
My email: ______________________________________
Leave (3) blank until you provide this form to someone with
alegitimate business need, like when you are filing your report at the police station or sending the form
to a credit reporting agency to correct your credit report.
At the Time of the Fraud
(8)My full legal name was: ____________________________________________
(9)My address was: _________________________________________________
Number & Street Name
Apartment, Suite, etc.
Skip (8) - (10) if your information has not changed since the fraud.
(10)My daytime phone: (____)_________________ My evening phone: (____)_________________
My email: _____________________________________
The Paperwork Reduction Act requires the FTC to display a valid control number (in this case, OMB control #3084-0047)
before we can collect – or sponsor the collection of – your information, or require you to provide it.
Victim’s Name _______________________________ Phone number (____)_________________ Page 2
About You (the victim) (Continued)
Declarations
(11)
I
did
OR
did not
authorize anyone to use my name or personal information to
obtain money, credit, loans, goods, or services — or for any
other purpose — as described in this report.
(12)
receive any money, goods, services, or other benefit as a
result of the events described in this report.
(13)
am
am not
willing to work with law enforcement if charges are brought
against the person(s) who committed the fraud.
About the Fraud
(14) I believe the following person used my information or identification
(14):
Enter what
documents to open new accounts, use my existing accounts, or commit other
you know
fraud.
about anyone
you believe
Name: ___________________________________________________
was involved
(even if you
don’t have
Address: __________________________________________________
complete
information).
__________________________________________________________
Phone Numbers: (____)_______________ (____)________________
Additional information about this person: _____________________________________
_______________________________________________________________________
Victim’s Name _______________________________ Phone number (____)_________________ Page 3
(15)Additional information about the crime (for example, how the identity thief gained access to your information or which documents or information were used):
________________________________________________________________
(14)and (15): Attach additional sheets as needed.
______________________________________________________________________________
Documentation
(16)I can verify my identity with these documents:
A valid government-issued photo identification card (for example, my driver’s license, state-issued ID card, or my passport).
If you are under 16 and don’t have a photo-ID, a copy of your birth certificate or a copy of your official school record showing your enrollment and legal address is acceptable.
Proof of residency during the time the disputed charges occurred, the loan was made, or the other event took place (for example, a copy of a rental/lease agreement in my name, a utility bill, or an insurance bill).
(16): Reminder: Attach copies of your identity documents when sending this form to creditors
and credit reporting agencies.
About the Information or Accounts
(17)The following personal information (like my name, address, Social Security number, or date of birth) in my credit report is inaccurate as a result of this identity theft:
(A)__________________________________________________________________________
(B)__________________________________________________________________________
(C)__________________________________________________________________________
(18)Credit inquiries from these companies appear on my credit report as a result of this identity theft:
Company Name: _______________________________________________________________
Victim’s Name _______________________________ Phone number (____)_________________ Page 4
(19)Below are details about the different frauds committed using my personal information.
___________________________________________________________________
Name of InstitutionContact Person Phone Extension
Account Number
Routing Number
Affected Check Number(s)
Account Type:
Credit
Bank
Phone/Utilities
Loan
Government Benefits
Internet or Email
Other
Select ONE:
This account was opened fraudulently.
This was an existing account that someone tampered with.
Date Opened or Misused (mm/yyyy) Date Discovered (mm/yyyy) Total Amount Obtained ($)
(19):
If there were more than three frauds, copy this page blank, and attach as many additional copies as necessary.
Enter any applicable information that you have, even if it is incomplete or an estimate.
If the thief committed two types of fraud at one company, list the company twice, giving the information about the two frauds separately.
Contact Person: Someone you dealt with, whom an investigator can call about this fraud.
Account Number: The number of the credit or debit card, bank account, loan, or other account that was misused.
Dates: Indicate when the thief began to misuse your information and when you discovered the problem.
Amount Obtained: For instance, the total amount purchased with the card or withdrawn from the account.
Victim’s Name _______________________________ Phone number (____)_________________ Page 5
Your Law Enforcement Report
(20)One way to get a credit reporting agency to quickly block identity theft- related information from appearing on your credit report is to submit a detailed law enforcement report (“Identity Theft Report”). You can obtain an Identity Theft Report by taking this form to your local law enforcement office, along with your supporting documentation. Ask an officer to witness your signature and complete the rest of the information in this section. It’s important to get your report number, whether or not you are able to file in person or get a copy of the official law enforcement report. Attach a copy of any confirmation letter or official law enforcement report you receive when sending this form to credit reporting agencies.
I have not filed a law enforcement report.
I was unable to file any law enforcement report.
I filed an automated report with the law enforcement agency listed below.
I filed my report in person with the law enforcement officer and agency listed below.
____________________________________________________________________
Law Enforcement DepartmentState
____________________________
_____________________
Report Number
Filing Date (mm/dd/yyyy)
(20):
Check “I have not...” if you have not yet filed a report with law enforcement or you have chosen not to. Check “I was unable...” if you tried to file a report but law enforcement refused to take it.
Automated report:
Alaw enforcement report filed through an automated system, for example, by telephone, mail, or the Internet, instead of a face-to-face interview with a law enforcement officer.
Officer’s Name (please print)Officer’s Signature
(____)_______________
Badge Number
Phone Number
Did the victim receive a copy of the report from the law enforcement officer?
Yes OR
No
Victim’s FTC complaint number (if available): ________________________
Victim’s Name _______________________________ Phone number (____)_________________ Page 6
Signature
As applicable, sign and date IN THE PRESENCE OF a law enforcement officer, a notary, or a witness.
(21)I certify that, to the best of my knowledge and belief, all of the information on and attached to this complaint is true, correct, and complete and made in good faith. I understand that this complaint or the information it contains may be made available to federal, state, and/or local law enforcement agencies for such action within their jurisdiction as they deem appropriate. I understand that knowingly making any false or fraudulent statement or representation to the government may violate federal, state, or local criminal statutes, and may result in a fine, imprisonment, or both.
_______________________________________
_________________________________________
Date Signed (mm/dd/yyyy)
Your Affidavit
(22)If you do not choose to file a report with law enforcement, you may use this form as an Identity Theft Affidavit to prove to each of the companies where the thief misused your information that you are not responsible for the fraud. While many companies accept this affidavit, others require that you submit different forms. Check with each company to see if it accepts this form. You should also check to see if it requires notarization. If so, sign in the presence of a notary. If it does not, please have one witness (non-relative) sign that you completed and signed this Affidavit.
Notary
Witness:
Printed Name
Date
Telephone Number
Filing the FTC Identity Theft Affidiction form is an important step for individuals who have experienced identity theft. This process contributes to reporting the incident to law enforcement and contesting fraudulent charges or accounts opened in one's name. The form acts as a formal declaration of the theft, and completing it meticulously is crucial for a smooth resolution process.
After the form has been thoroughly completed and submitted, individuals should maintain copies of all submitted documents and communications. Monitoring credit reports and accounts for further fraudulent activity is advised. Follow up with law enforcement, credit bureaus, and any financial institutions involved to ensure the matter is fully resolved.
What is the FTC Identity Theft Affidavit form?
The FTC Identity Theft Affidavit form is a voluntary document for reporting identity theft issues to law enforcement, credit reporting agencies, and creditors. It helps in disputing unauthorized transactions and fraudulent accounts opened in your name.
How long does it take to complete the FTC Identity Theft Affidavit form?
On average, it takes about 10 minutes to complete the form.
What should I do before filling out the FTC Identity Theft Affidavit form?
Can I submit the FTC Identity Theft Affidavit form online?
Yes, a secure online version of the form is available at ftc.gov/idtheft, which you can print for your records after completing.
What information do I need to provide in the FTC Identity Theft Affidavit form?
You need to provide personal information, details about the fraud, including how the identity thief accessed your information, and documentation verifying your identity. Specific details about any fraudulent accounts or transactions should also be included.
Do I need to attach any documents when submitting the FTC Identity Theft Affidavit form?
Yes, you should attach copies of your identity verification documents, such as a government-issued photo ID, and documents proving your residency during the time the disputed transactions occurred.
What should I do if my information hasn’t changed since the fraud occurred?
If your personal information, such as your name and address, has not changed since the time of the fraud, you can skip the section of the form that asks for information "At the time of the fraud."
How do I report the identity theft to law enforcement?
You should take the FTC Identity Theft Affidavit form to your local law enforcement office along with your supporting documentation to file a detailed law enforcement report or "Identity Theft Report". It's important to obtain a report number and attach any confirmation letter or official law enforcement report when sending the form to credit reporting agencies.
What if I am unable to file a law enforcement report?
If you tried to file a report but law enforcement refused to take it, you should check the respective option on the form indicating that you were unable to file any law enforcement report.
Can I file a law enforcement report through an automated system?
Yes, the form allows you to indicate if you filed an automated report with law enforcement through methods such as telephone, mail, or the internet. You should include the details of the agency you reported the fraud to.
Filling out the FTC Identity Theft Affidavit form is a crucial step in reclaiming your identity and rectifying the financial turmoil caused by identity theft. However, mistakes can occur during this process, leading to potential delays or complications in resolving your case. Here are five common errors that individuals should avoid.
Avoiding these mistakes can significantly streamline the recovery process from identity theft. It is crucial for individuals to complete the FTC Identity Theft Affidavit with precision and care, ensuring that all information provided is accurate, comprehensive, and duly verified. Addressing these potential pitfalls upfront can aid in a smoother resolution and faster recovery of one’s identity and financial health.
Filing an FTC Identity Theft Affidavit form is often just the beginning of the journey toward resolving identity theft. This crucial step is accompanied by several other documents that victims might need to gather and submit to various agencies to ensure their identity is protected and to dispute fraudulent activities. Below is a concise list of such documents and a brief description of each.
Gathering these documents might seem overwhelming but, taking it step by step is vital for protecting your identity and financial future. Keep records organized, and don't hesitate to seek assistance from legal or financial professionals specializing in identity theft recovery. This structured approach will pave the way to regaining control of your personal information and credit health.
The Police Report for Identity Theft closely mirrors the FTC Identity Theft Affidavit form in its objective to document the specifics of an identity theft case. Like the FTC affidavit, a police report requires victims to provide detailed information about the crime, including their personal details, the nature of the theft, and any known information about the identity thief. The police report is instrumental in initiating a law enforcement investigation into the matter and serves a similar purpose to the FTC Affidavit by formally recording an instance of identity theft.
A Fraud Alert Request form shares a similar purpose with the FTC Identity Theft Affidavit as both are proactive measures taken following identity theft. When individuals place a fraud alert on their credit reports, they alert creditors and credit agencies to the risk of fraud within their credit files. This document, like the FTC affidavit, is essential for protecting the victim’s credit health post-identity theft and requires them to provide their personal information and details of their identity theft concern.
The Credit Dispute Letter is another document that bears resemblance to the FTC Identity Theft Affidavit in its use as a tool for correcting inaccuracies within credit reports due to fraudulent activities. Victims of identity theft use this letter to communicate with credit bureaus and dispute erroneous information, ranging from unauthorized accounts to fraudulent transactions. Similar to the affidavit, this letter helps in rectifying credit report inaccuracies stemming from identity theft by providing detailed account disputations.
The Affidavit of Fraud provided by individual banks and credit issuers also shares similarities with the FTC Identity Theft Affidavit. This document is used to formally dispute unauthorized transactions and fraudulent account openings with financial institutions. It necessitates detailed descriptions of the wrongful acts, akin to the FTC Affidavit, and serves to absolve the victim of financial responsibilities associated with the fraud, thereby helping to restore the victim’s financial integrity.
Lastly, the IRS Identity Theft Affidavit (Form 14039) complements the FTC Identity Theft Affidavit by focusing on tax-related identity theft. This form is utilized when someone has misused a person’s information to file a fraudulent tax return or commit other tax fraud activities. Like the FTC affidavit, it helps to report the identity theft directly to a federal agency and initiates the process of resolving the fraudulent activity with the goal of protecting the victim’s tax records and recovering any stolen refunds.
Filling out the FTC Identity Theft Affidavit form is a crucial step towards reclaiming your identity and repairing the damage. Here are vital dos and don'ts to consider during the process:
When it comes to the Federal Trade Commission (FTC) Identity Theft Affidavit form, there are several misconceptions that people frequently have. Correcting these misunderstandings is crucial for individuals dealing with the fallout from identity theft. Here are four common misconceptions and the truths behind them:
Many believe that once they fill out and submit the FTC Identity Theft Affidavit, their part is done. However, this form is just the beginning. It's a tool to help you communicate with law enforcement and businesses about the identity theft. You'll also need to report the theft to the three major credit reporting agencies, close any fraudulent accounts opened in your name, and place fraud alerts or a credit freeze on your credit reports.
Another common misunderstanding is that the affidavit has an immediate effect on your credit report and accounts. In reality, it serves as a formal complaint and provides a detailed account of the identity theft but does not automatically resolve the issues. It's your responsibility to provide the affidavit to creditors and credit bureaus to dispute fraudulent transactions and accounts.
Some people hesitate to fill out the affidavit because they don't have all the details of how the theft occurred or who the thief is. It's important to understand that you should fill out the form with as much information as you currently have. The form is designed to help start the investigation process, and not having complete information should not deter you from reporting the theft.
While it's true that the affidavit is crucial for disputing fraudulent information on your credit report, its usefulness doesn't stop there. It's also a critical document for disputing fraudulent charges with creditors, filing a police report, and may serve as evidence in legal proceedings related to the identity theft. Therefore, its role is significant in various aspects of reclaiming your identity and rectifying your financial situation.
Understanding these misconceptions about the FTC Identity Theft Affidavit form is essential for effectively navigating the process of recovering from identity theft. Remember, patience and persistence are key, as resolving identity theft issues can be a complex and time-consuming process.
Filling out the FTC Identity Theft Affidavit form is an essential step in reclaiming your identity and resolving any related issues. Here are the key takeaways to guide you through the process:
By following these steps and completing the FTC Identity Theft Affidavit with care, you’ll arm yourself with a solid foundation to dispute fraudulent activity and start the process of recovery.
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