The FTC Identity Theft Affidavit form is a voluntary document designed for victims of identity theft. It allows individuals to report incidents to law enforcement and dispute fraudulent activity with credit reporting agencies and creditors. If you believe you’ve been a victim, take the first step towards resolution by filling out the form below.
Identity theft can be a distressing experience, leaving victims feeling vulnerable and overwhelmed. The FTC Identity Theft Affidavit form serves as a vital tool for those affected, enabling them to formally report the incident and take necessary steps toward recovery. This voluntary form is designed to help individuals file a report with law enforcement and dispute fraudulent charges with credit reporting agencies and creditors. Completing the affidavit typically takes about 10 minutes, making it a manageable task in a challenging situation. Before filling out the form, it’s important to take preliminary actions, such as placing a fraud alert on your credit reports and reviewing them for any signs of unauthorized activity. The form requires personal information about the victim, including their full legal name, date of birth, Social Security number, and current address. Additionally, it prompts the victim to detail the fraudulent activities, providing space to identify any individuals involved and describe how the identity theft occurred. Documentation is crucial, and the form guides users on what to include, such as government-issued ID and proof of residency. Once completed, the affidavit can be submitted to law enforcement and credit agencies, helping to initiate the process of reclaiming one’s identity and restoring financial security.
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
Completing the FTC Identity Theft Affidavit form is an essential step for victims of identity theft. This form helps in filing a report with law enforcement and disputing fraudulent activities with credit reporting agencies. Once the form is filled out, it can be submitted to the appropriate authorities to assist in resolving identity theft issues.
The FTC Identity Theft Affidavit is a voluntary form that helps victims of identity theft document their experiences. It serves as a report to law enforcement and aids in disputes with credit reporting agencies and creditors regarding identity theft-related issues. Completing this form can streamline the process of addressing the consequences of identity theft.
On average, it takes about 10 minutes to complete the FTC Identity Theft Affidavit form. However, the time may vary depending on the complexity of your situation and the amount of information you need to provide.
Before you complete the affidavit, it is essential to take a few preliminary steps:
The form should be filled out by the victim of identity theft. This includes providing your personal information, such as your name, address, and Social Security number. If your information has changed since the fraud occurred, you should include that information as well.
You will need to provide various details, including:
You can submit the FTC Identity Theft Affidavit form to law enforcement when you file your report. It is also advisable to send copies of the form to credit reporting agencies and creditors to dispute any fraudulent charges. Make sure to keep a copy for your records.
If you need help while completing the form, consider reaching out to consumer protection agencies or legal aid organizations. They can provide guidance and support to ensure that your affidavit is filled out correctly and submitted properly.
Filling out the FTC Identity Theft Affidavit form can be a daunting task, especially for those who have already experienced the distress of identity theft. Unfortunately, many individuals make mistakes that can hinder their ability to resolve their issues effectively. Here are nine common errors to avoid.
First, people often forget to place a fraud alert on their credit reports before completing the form. This step is crucial, as it alerts creditors to take extra precautions when verifying identity. Without this alert, you may find it more challenging to dispute fraudulent accounts later on.
Secondly, some individuals skip reviewing their credit reports for signs of fraud. It’s important to know exactly what has been tampered with or opened fraudulently. Missing this step can lead to incomplete information on the affidavit, which may delay the resolution process.
Another common mistake is failing to provide accurate personal information. When filling out sections about your current and previous addresses, it’s essential to double-check for typos. Errors in your name, Social Security number, or contact information can create confusion and complicate your case.
Many people also neglect to indicate whether they authorized anyone to use their information. This declaration is significant because it helps establish the nature of the fraud. Omitting this detail can raise questions about the validity of your claim.
Additionally, individuals sometimes forget to include supporting documentation. The affidavit requires proof of identity and residency. Without attaching copies of these documents, your report may not be taken seriously, potentially prolonging the resolution process.
Another frequent error is not providing enough detail about the fraud itself. When describing how the identity thief gained access to your information, be as specific as possible. Vague descriptions can lead to misunderstandings and may hinder law enforcement's ability to take action.
People also often overlook the importance of keeping a copy of the completed affidavit. This document serves as a record of your claim and can be useful in future communications with creditors or law enforcement. Not having a copy can leave you unprepared if further action is needed.
Moreover, some individuals fail to follow up with law enforcement after filing their report. It’s vital to obtain a report number and ensure that you receive a copy of the official report. This documentation is often required by credit reporting agencies to block fraudulent information from your credit report.
Lastly, many forget to check their credit reports regularly after submitting the affidavit. Identity theft can lead to ongoing issues, and being proactive about monitoring your credit can help catch any new fraudulent activity early.
By avoiding these common mistakes, you can navigate the FTC Identity Theft Affidavit form more effectively and increase your chances of resolving your identity theft issues quickly and efficiently.
When dealing with identity theft, it's essential to gather the right documents to support your case. Along with the FTC Identity Theft Affidavit form, there are several other important forms and documents that can help streamline the process of reporting and resolving identity theft issues. Here’s a brief overview of these documents.
Collecting these documents can make a significant difference in resolving identity theft issues. Stay organized and proactive to protect your rights and restore your identity.
The FTC Identity Theft Affidavit form serves as a crucial tool for individuals who have fallen victim to identity theft. It allows victims to report the crime and initiate the process of rectifying the damage done to their personal and financial information. Several other documents share similar purposes and functionalities. Below is a list of nine such documents, each with a brief explanation of how they relate to the FTC Identity Theft Affidavit form.
When filling out the FTC Identity Theft Affidavit form, it is crucial to follow specific guidelines to ensure accuracy and efficiency. Here’s a list of things you should and shouldn't do:
There are several misconceptions about the FTC Identity Theft Affidavit form that can lead to confusion for victims of identity theft. Understanding these misconceptions can help individuals navigate the process more effectively.
In reality, the FTC Identity Theft Affidavit is a voluntary form. While it can be very helpful for filing reports with law enforcement and disputing fraudulent activity with credit reporting agencies, it is not required to report identity theft.
Filing the affidavit does not automatically erase fraudulent charges from your credit report. It serves as documentation to support your claims, but you still need to work with creditors and credit reporting agencies to resolve specific issues.
While it is important to provide as much accurate information as possible, the form allows for some flexibility. If certain details are unknown, it is acceptable to leave them blank or provide estimates. The goal is to provide sufficient information to assist in the investigation.
The FTC Identity Theft Affidavit can be submitted online or printed for personal records. Victims can also send it to creditors and credit reporting agencies by mail. This flexibility allows individuals to choose the method that best suits their situation.
Filling out the FTC Identity Theft Affidavit form is a crucial step for victims of identity theft. Here are some key takeaways to consider: