The FTC Identity Theft Affidavit form is a critical tool for victims of identity theft. It serves as a formal complaint and affidavit for reporting identity theft incidents to law enforcement and disputing fraudulent transactions with credit reporting agencies and creditors. By completing this form, victims can take the first essential step towards reclaiming their financial health and personal integrity. For a secure and streamlined process, victims are encouraged to fill out the form online, where it can also be printed for record-keeping purposes. Start the process of safeguarding your identity by clicking the button below to fill out the FTC Identity Theft Affidavit form.
When dealing with the fallout of identity theft, individuals are often advised to take definitive steps towards reclaiming their financial security and personal peace of mind. One crucial step in this process involves completing the Identity Theft Victim’s Complaint and Affidavit form, provided by the Federal Trade Commission (FTC). This document serves multiple purposes: it acts as a formal complaint to law enforcement, and it is used in disputes with credit reporting agencies and creditors regarding identity theft-related issues. The form, which on average takes about 10 minutes to complete, can be accessed through a secure online version at ftc.gov/idtheft, allowing users to print a copy for their records. Before filling out the affidavit, victims are encouraged to place a fraud alert on their credit reports and close any accounts that have been compromised or opened fraudulently. The form requires detailed personal information, including full legal name, Social Security number, and current address, with reminders to leave sensitive details blank until necessary for security reasons. Additionally, it provides space for declaring whether any benefits were received from the unauthorized use of identity and whether the victim is willing to assist law enforcement in prosecuting the perpetrators. To further aid in the recovery process, victims must detail the fraudulent activities, including any known information about the identity thief, and submit supporting documents to verify their identity. This comprehensive approach is designed to facilitate the resolution of identity theft issues, offering victims a structured way to report and dispute fraudulent activities effectively.
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 Affidavit is a critical step in reclaiming your identity and resolving issues caused by identity theft. This document, designed by the Federal Trade Commission (FTC), assists victims in disputing unauthorized accounts and transactions with credit bureaus and creditors. Completing this form also enables you to create a detailed report, which can be taken to the police, further legitimizing the fraud claims. Here's a step-by-step guide on how to fill out this form thoroughly and accurately.
After completing the form, remember to attach a copy of any supporting documentation you have. This might include your identity verification documents, any additional sheets providing more information on the fraud, and a copy of your law enforcement report if available. Taking these steps can significantly help in the process of recovering from identity theft and regaining control over your personal and financial information.
The FTC Identity Theft Affidavit is a document provided by the Federal Trade Commission that helps victims of identity theft report unauthorized use of their information. It's used to file a complaint with law enforcement and dispute inaccuracies with credit reporting agencies and creditors. It's a voluntary form that streamlines the process of documenting identity theft and assists in recovery efforts.
On average, it takes about 10 minutes to complete the FTC Identity Theft Affidavit, depending on the specifics of your situation and how much information you have readily available.
Before filling out the affidavit, you should:
This helps in preventing further misuse of your information and is crucial in the recovery process.
You will need to provide personal information including:
Note: Your Social Security number should only be provided when necessary, for example, when submitting the form to a police station or credit reporting agency.
Yes, a secure online version of the FTC Identity Theft Affidavit is available at ftc.gov/idtheft. After completing the form online, you can print it for your records, which is useful for any disputes with credit reporting agencies or creditors.
Yes, you are reminded to attach copies of your identity documents when sending the form to creditors and credit reporting agencies. This includes your government-issued photo ID and proof of residency during the time the fraud occurred.
If you discover more frauds, you should fill out a new section of the form for each instance. If needed, you can copy the page detailing the frauds and attach as many additional copies as necessary. Make sure to include any applicable information, even if it's incomplete or an estimate.
You can obtain an Identity Theft Report by taking the completed FTC Identity Theft Affidavit to your local law enforcement office along with any supporting documentation. An officer will witness your signature and complete the law enforcement section. It’s important to get a report number and attach any official law enforcement report or confirmation letter when sending the form to credit reporting agencies.
If law enforcement refuses to take your report, you can check the box indicating you were unable to file a law enforcement report on the FTC Identity Theft Affidavit. Documenting this attempt is important, as it can still assist in your disputes with credit reporting agencies and creditors.
When filling out the FTC Identity Theft Affidavit form, individuals often make mistakes that can complicate or delay the resolution of their case. These mistakes can range from minor oversights to significant errors that impact the effectiveness of the affidavit. Here are nine common mistakes:
By avoiding these mistakes, individuals can ensure their FTC Identity Theft Affidavit is as effective as possible in helping to rectify issues arising from identity theft.
When dealing with identity theft, the FTC Identity Theft Affidavit form is a critical first step for victims to reclaim their identity and resolve related issues. However, this form is often just the start of the paperwork process. A variety of other documents and forms are typically needed to fully address the situation. Understanding these documents can significantly streamline the recovery process for identity theft victims.
Each of these documents plays a vital role in the journey to recover from identity theft. Victims are encouraged to be thorough and proactive in gathering and submitting all necessary paperwork. By doing so, they can help ensure a smoother and more efficient resolution process.
Police Report: Similar to the FTC Identity Theft Affidavit, a police report is filed with local law enforcement to officially document an incident or crime, such as theft or fraud. Both documents are used for reporting purposes and can be critical for investigations and legal actions related to identity theft.
Credit Dispute Letter: This document is sent to credit bureaus to dispute errors on a credit report, much like how the affidavit is used to dispute fraudulent accounts and transactions resulting from identity theft. Both require detailed personal information and descriptions of the disputed issue.
Fraud Alert Request: When placing a fraud alert on one’s credit file, the request form requires similar personal and fraud details as the affidavit. Both serve to protect the individual from further damage by alerting institutions of the identity theft.
Data Breach Notification: If an individual's personal information is exposed during a data breach, they may receive a notification with instructions similar to actions advised by the FTC, such as monitoring credit reports and using the affidavit to dispute fraudulent activities.
Account Closure Request: When closing accounts due to fraud, you must provide detailed identification and account information, akin to the process of completing the FTC Affidavit, to ensure secure and verified closure of the compromised accounts.
Identity Theft Insurance Claim Form: This is filed to claim insurance for losses due to identity theft. Like the FTC affidavit, it requires detailed theft information, personal identification, and often, documentation of the steps taken to mitigate and report the theft.
Bank Fraud Claim Form: When reporting fraudulent transactions to a bank, customers fill out a claim form that gathers similar information to the FTC affidavit regarding their identity and the nature of the fraudulent activity on their accounts.
Credit Freeze Request: A request to freeze credit requires identification verification and a detailed personal account, similar to the affidavit. A freeze is a step beyond a fraud alert, preventing new credit from being opened in the individual’s name entirely.
Court Petition for Declaration of Innocence: In cases where identity theft leads to wrongful criminal charges, victims may need to petition the court for a declaration of innocence, requiring detailed documentation of identity theft, potentially including the FTC affidavit as supporting evidence.
Consumer Complaint Form: Filed with consumer protection agencies about issues with products, services, or companies, including identity theft protection services that fail to deliver as promised. It requires personal information and a narrative of the complaint, similar to the affidavit process.
Filling out the FTC Identity Theft Affidavit is a critical step toward recovering from identity theft. This document will serve as an essential tool in disputing fraudulent accounts and transactions made in your name. Here are important dos and don'ts to keep in mind:
What You Should Do
What You Shouldn't Do
When tackling identity theft, the FTC Identity Theft Affidavit is a critical tool. However, there are several misconceptions surrounding its use and effectiveness. Understanding these can help victims more effectively navigate their recovery process.
This belief is incorrect. While the FTC Identity Theft Affidavit is an important part of reporting identity theft and disputing unauthorized accounts or transactions with creditors and credit bureaus, it is often just the first step. Victims might also need to file a police report, submit additional documentation to creditors or credit bureaus, and take other steps depending on the complexity of their identity theft case.
Another common misunderstanding is the belief that once the affidavit is completed, the victim's identity theft issues will be resolved right away. In reality, resolving identity theft can be a lengthy process. The affidavit serves to formally dispute unauthorized transactions and accounts. However, the time to resolve these disputes can vary greatly depending on the severity of the theft, the entities involved, and the responsiveness of creditors and credit bureaus.
This is not the case. The FTC Identity Theft Affidavit is designed to help victims report identity theft to law enforcement and dispute fraudulent accounts and transactions not only with credit reporting agencies but also with creditors directly. It provides a standardized way of communicating a victim’s claim of identity theft, which can be used across a variety of entities involved in credit and finance.
Some individuals worry that filing the FTC Identity Theft Affidavit might expose them to further risk, as it involves providing personal information. However, the form is a secure means of reporting identity theft. Victims are advised to submit their affidavit directly to law enforcement or other verified entities. It's important to follow secure transmission methods, such as using encrypted email or secure online forms, or mailing through trusted courier services when submitting the affidavit and any supporting documentation.
In essence, while the FTC Identity Theft Affidavit is a vital document for victims of identity theft, navigating the misconceptions surrounding its use is equally important. Understanding what the affidavit can and cannot do empowers victims to take the appropriate actions towards reclaiming their financial identity.
When dealing with identity theft, the Federal Trade Commission (FTC) Identity Theft Affidavit form is a crucial first step in reclaiming your financial security. Here are ten key takeaways to guide you through filling out and using this form:
Completing the FTC Identity Theft Affidavit form with thorough and accurate information, and following through with all recommended steps, are key to regaining control over your personal and financial information. It's a process that requires patience and persistence, but with the right approach, individuals can overcome the challenges posed by identity theft.
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