Fill in a Valid Ftc Identity Theft Affidavit Template

The FTC Identity Theft Affidavit form is a voluntary document that helps victims of identity theft file reports with law enforcement and dispute issues with credit reporting agencies and creditors. Completing this form can be crucial for recovering from identity theft and correcting your credit report. Take the first step towards reclaiming your identity by filling out the form below.

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The FTC Identity Theft Affidavit form serves as a crucial tool for individuals who have fallen victim to identity theft. Completing this form allows victims to file a report with law enforcement and initiate disputes with credit reporting agencies and creditors regarding fraudulent activities linked to their identity. The form typically takes around ten minutes to complete and can be accessed online at ftc.gov/idtheft, where users can fill it out securely and print it for their records. Before starting the process, victims should place a fraud alert on their credit reports and review them for any signs of unauthorized activity. The affidavit requires personal information, including the victim's full legal name, date of birth, Social Security number, and current address, as well as details about the fraudulent activity. It includes sections where victims can declare whether they authorized the use of their information and provide information about the identity thief and the fraud committed. Documentation is also necessary to verify identity and residency during the time of the fraud. Finally, victims are encouraged to obtain a law enforcement report, which can expedite the process of blocking fraudulent information from their credit reports.

Ftc Identity Theft Affidavit Example

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

State

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: ____________________________________________

First

Middle

Last

Suffix

(9)My address was: _________________________________________________

Number & Street Name

Apartment, Suite, etc.

Skip (8) - (10) if your information has not changed since the fraud.

_______________________________________________________________

City

State

Zip Code

Country

(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)	I	did	OR	did not	receive any money, goods, services, or other benefit as a
					result of the events described in this report.
(13)	I	am	OR	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
Name: ___________________________________________________				(even if you
First	Middle	Last	Suffix	(even if you
First	Middle	Last	Suffix	don’t have
				don’t have
Address: __________________________________________________				complete
Address: __________________________________________________				information).
Number & Street Name		Apartment, Suite, etc.
__________________________________________________________
City	State	Zip Code	Country

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 ($)

___________________________________________________________________

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 ($)

___________________________________________________________________

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.

Select ONE:

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.

_______________________________________	_________________________________________
Signature	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:

_______________________________________	_________________________________________
Signature	Printed Name

_______________________________________	_________________________________________
Date	Telephone Number

Click for Ftc Identity Theft Affidavit File

File Breakdown

Fact Name	Details
Average Completion Time	It takes approximately 10 minutes to complete the FTC Identity Theft Affidavit form.
Purpose of the Form	This form is used to report identity theft to law enforcement and to dispute issues with credit reporting agencies and creditors.
Online Access	A secure online version of the form is available at ftc.gov/idtheft, which can be printed for personal records.
Fraud Alert Requirement	Before filling out the form, victims should place a fraud alert on their credit reports and review them for any signs of fraud.
Documentation Needed	Victims must provide valid identification, such as a government-issued photo ID, and proof of residency.
Law Enforcement Report	Submitting a law enforcement report can expedite the process of blocking identity theft-related information from credit reports.
Control Number	The FTC displays a valid control number (OMB control #3084-0047) as required by the Paperwork Reduction Act.
State-Specific Forms	Each state may have its own requirements regarding identity theft reporting, governed by local laws.

Guide to Using Ftc Identity Theft Affidavit

After completing the FTC Identity Theft Affidavit form, you will need to submit it to law enforcement or relevant credit reporting agencies. Make sure to keep a copy for your records. Follow the steps below to fill out the form accurately.

Begin by writing your full legal name in the designated space, including your first, middle, last, and suffix.
Enter your date of birth in the mm/dd/yyyy format.
Provide your Social Security number in the format of XXX-XX-XXXX.
Fill in your driver’s license number and the state it was issued in.
Write your current street address, including apartment or suite number, city, state, zip code, and country.
Indicate how long you have lived at this address by entering the date in mm/yyyy format.
List your daytime and evening phone numbers, as well as your email address.
If your information has changed since the fraud, provide your full legal name, previous address, and contact information as needed.
Answer the declarations regarding authorization of use of your personal information and whether you received any benefits from the fraud.
Provide the name and address of anyone you believe used your information fraudulently.
Detail how the identity thief gained access to your information and what documents were used.
List the documents you can provide to verify your identity, such as a government-issued photo ID or proof of residency.
Identify any inaccurate personal information on your credit report due to identity theft.
List any credit inquiries from companies that appear on your credit report as a result of the identity theft.
Detail the different frauds committed using your personal information, including the name of the institution, account number, and type of fraud.
If applicable, indicate whether you have filed a law enforcement report and provide the necessary details.

Get Answers on Ftc Identity Theft Affidavit

What is the FTC Identity Theft Affidavit form?

The FTC Identity Theft Affidavit form is a voluntary document designed for victims of identity theft. It allows individuals to report their situation to law enforcement and dispute fraudulent charges with credit reporting agencies and creditors. You can access a secure online version of the form at ftc.gov/idtheft.

How long does it take to complete the form?

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.

What should I do before filling out the form?

Before completing the affidavit, follow these steps:

Place a fraud alert on your credit reports.
Review your credit reports for any signs of fraud.
Close any accounts that you know or suspect have been tampered with or opened fraudulently.

What information do I need to provide about myself?

You will need to provide several details, including:

Your full legal name.
Your date of birth.
Your Social Security number.
Your driver's license information.
Your current address and how long you've lived there.
Your daytime and evening phone numbers.
Your email address.

Make sure to leave some sections blank until you provide the form to a legitimate business, like a police station or credit reporting agency.

What if my information has changed since the fraud?

If your information has changed since the fraud occurred, you will need to fill out the relevant sections with your previous details. This includes your full legal name, address, and contact information at the time of the fraud.

What kind of documentation do I need to verify my identity?

To verify your identity, you should provide:

A valid government-issued photo ID, such as a driver's license or passport.
If you are under 16 and do not have a photo ID, a copy of your birth certificate or official school record is acceptable.
Proof of residency during the time the disputed charges occurred, like a rental agreement or utility bill.

Remember to attach copies of these documents when sending the form to creditors and credit reporting agencies.

How do I report the fraud to law enforcement?

To report the fraud, take the completed affidavit to your local law enforcement office along with any supporting documentation. An officer will need to witness your signature and complete the necessary information on the form. Make sure to get a report number, as this will help in blocking identity theft-related information from your credit report.

What if I have not filed a law enforcement report?

If you have not filed a report, simply check the appropriate box on the affidavit. If you attempted to file a report but were unable to do so, you can indicate that as well. It's important to document any attempts you made to report the fraud.

What should I do after completing the form?

After completing the FTC Identity Theft Affidavit form, make sure to keep a copy for your records. Send the form, along with any required documentation, to the relevant creditors and credit reporting agencies. Follow up to ensure that they have received your information and are taking appropriate action.

Common mistakes

Filling out the FTC Identity Theft Affidavit form can be a daunting task, especially for those who have already experienced the stress of identity theft. Mistakes made during this process can delay resolution and complicate matters further. Here are ten common errors that individuals often make when completing this important form.

One frequent mistake is failing to provide complete personal information. It is crucial to fill in all sections accurately, including your full legal name, date of birth, and Social Security number. Omitting any of this information can lead to delays in processing your report.

Another common error involves not reviewing credit reports before filling out the affidavit. Before you complete the form, it is essential to place a fraud alert on your credit reports and check for any signs of fraudulent activity. This step helps ensure that you are aware of all fraudulent accounts that may need to be reported.

People also often neglect to close fraudulent accounts before submitting the affidavit. If you know or suspect that certain accounts have been tampered with, closing them is a necessary step. Failing to do so can lead to further complications down the line.

Inaccurate information about the fraud itself is another area where mistakes occur. Some individuals do not provide enough detail regarding how the identity thief gained access to their information. Clear and specific descriptions can help law enforcement understand the situation better and take appropriate action.

Many people mistakenly skip sections of the form that do not seem relevant. For instance, if your information has changed, it is important to update all sections, even if it feels repetitive. Each detail can be significant in building a complete picture of the fraud.

Moreover, individuals often forget to attach necessary documentation. The affidavit requires supporting documents, such as a government-issued ID and proof of residency. Without these attachments, your report may not be accepted or processed efficiently.

Another mistake is not keeping copies of submitted forms. After filling out the affidavit, it is wise to make copies for your records. This can be helpful if any issues arise later or if you need to provide proof of your submission.

Some individuals also overlook the importance of the law enforcement report. It is essential to file a report with local law enforcement and obtain a report number. This step is crucial for establishing a formal record of the identity theft and can aid in resolving disputes with creditors.

People sometimes misunderstand the purpose of the affidavit. This form is not just a report; it is a tool to help you dispute fraudulent charges and accounts. Understanding its purpose can help you fill it out more effectively.

Lastly, individuals often rush through the form without taking the time to double-check their entries. Mistakes made in haste can lead to significant delays in resolving identity theft issues. Taking a moment to review your answers can save time and stress in the long run.

Documents used along the form

When dealing with identity theft, the FTC Identity Theft Affidavit form is a crucial document. However, several other forms and documents can enhance your efforts to resolve issues stemming from identity theft. Below is a list of commonly used documents that may accompany the affidavit.

Law Enforcement Report: This report is created when you file a complaint with local law enforcement regarding identity theft. It serves as an official record of the crime and can help you in disputing fraudulent accounts and claims with creditors and credit reporting agencies.
Credit Report: Obtaining a copy of your credit report is essential. It allows you to review any unauthorized accounts or inquiries that may have resulted from identity theft. You can request a free report annually from each of the three major credit bureaus.
Fraud Alert: Placing a fraud alert on your credit reports notifies potential creditors to take extra steps in verifying your identity before issuing credit. This alert can be initiated by contacting one of the major credit bureaus, which will then notify the others.
Identity Theft Report: This document is generated when you file a report with the FTC or law enforcement. It is crucial for disputing fraudulent charges and accounts, as it provides a formal acknowledgment of the identity theft incident.

These documents, along with the FTC Identity Theft Affidavit, form a comprehensive approach to addressing and rectifying the consequences of identity theft. Each plays a vital role in protecting your rights and restoring your identity.

Similar forms

Police Report: Similar to the FTC Identity Theft Affidavit, a police report documents a crime that has occurred. It serves as an official record for law enforcement and can be used to support claims of identity theft or fraud.
Fraud Alert Request: This document requests that credit reporting agencies place a fraud alert on your credit report. Like the affidavit, it notifies creditors to take extra steps to verify identity before extending credit.
Credit Report Dispute Form: This form is used to dispute inaccuracies in a credit report. It is similar to the affidavit in that it requires personal information and details about the fraudulent activity affecting the report.
Identity Theft Report: Created when a victim files a report with law enforcement, this document is essential for proving identity theft. It shares similarities with the affidavit in its purpose of documenting the crime and aiding in recovery.
Consumer Complaint Form: This form is used to report issues with a business or service. Like the affidavit, it collects personal information and details about the complaint, serving to initiate an investigation.
Affidavit of Identity Theft: This document is often used in legal proceedings to affirm that a person is a victim of identity theft. It resembles the FTC form in that it requires a detailed account of the fraud and the victim’s personal information.
Victim Impact Statement: This statement outlines how the crime has affected the victim. It is similar to the affidavit in its focus on the personal consequences of identity theft and may be used in legal proceedings.
Credit Freeze Request: This request is made to credit reporting agencies to prevent new accounts from being opened in a victim's name. It parallels the affidavit by providing necessary personal information and details about identity theft.
Identity Theft Recovery Plan: This document outlines steps a victim can take to recover from identity theft. Like the affidavit, it addresses the actions needed to rectify the situation and protect against further fraud.
Consumer Fraud Report: This report is used to document instances of consumer fraud. It shares similarities with the FTC affidavit in its aim to provide a formal account of fraudulent activities affecting the victim.

Dos and Don'ts

When filling out the FTC Identity Theft Affidavit form, it’s essential to approach the task carefully. Here are five things you should and shouldn't do to ensure your application is processed smoothly.

Do place a fraud alert on your credit reports before filling out the form.
Do provide accurate and complete information about yourself and the fraud.
Do attach copies of any relevant documents that verify your identity.
Do keep a copy of the completed affidavit for your records.
Do follow up with law enforcement if you file a report.

Don't leave any sections of the form blank unless instructed to do so.
Don't submit the form without reviewing it for accuracy.
Don't forget to include your contact information for follow-up.
Don't delay in filing your affidavit; act as soon as you notice the fraud.
Don't ignore the importance of documenting your communications with creditors and law enforcement.

Misconceptions

Understanding the FTC Identity Theft Affidavit form can be challenging due to various misconceptions. Here are six common misunderstandings clarified:

It is mandatory to file a police report before using the affidavit. Many believe that a police report is a prerequisite for completing the affidavit. However, while having a report can strengthen your case, it is not required to use the affidavit itself.
The affidavit is only for credit reporting agencies. Some think the affidavit is solely for disputing inaccuracies with credit bureaus. In reality, it can also be used to file a report with law enforcement and communicate with creditors about fraudulent accounts.
You need to provide detailed personal information about the identity thief. A common misconception is that you must know everything about the thief to complete the form. You can still file the affidavit even if you have limited information about the perpetrator.
The affidavit guarantees the resolution of your identity theft issues. While the affidavit is a crucial step in addressing identity theft, it does not guarantee that all issues will be resolved immediately. It serves as a tool to help initiate the process.
Filling out the affidavit is a lengthy process. Some individuals worry that completing the affidavit will take a lot of time. In fact, it typically takes about 10 minutes to fill out the form, making it a manageable task.
You must send the affidavit to all creditors and agencies at once. There’s a misconception that the affidavit must be submitted to every creditor and agency simultaneously. You can prioritize which entities to notify based on your specific situation and the accounts affected.

Key takeaways

Filling out the FTC Identity Theft Affidavit form is an important step in addressing identity theft. Here are key takeaways to keep in mind:

Time to Complete: Expect to spend about 10 minutes filling out the form.
Purpose: This form helps you report identity theft to law enforcement and dispute inaccuracies with credit reporting agencies.
Fraud Alert: Before completing the form, place a fraud alert on your credit reports and review them for any signs of fraud.
Documentation: You will need to provide a valid government-issued ID and proof of residency when submitting the form.
Accurate Information: Fill in your personal details carefully, including your full legal name, address, and contact information.
Details of Fraud: Clearly describe how your information was misused and provide any relevant details about the identity thief.
Law Enforcement Report: Obtaining a law enforcement report can help block fraudulent information from your credit report.
Follow-Up: Keep copies of all documents and communications for your records, including the completed affidavit.
Support: If you need help, consider reaching out to a trusted friend or family member for assistance with the process.