Ftc Identity Theft Affidavit PDF Template

The FTC Identity Theft Affidavit form is a voluntary document that helps victims of identity theft report their situation to law enforcement and dispute any fraudulent activity with credit reporting agencies and creditors. Completing this form is an essential step in addressing identity theft-related issues and reclaiming your identity. If you believe you are a victim, fill out the form by clicking the button below.

Article Guide

The FTC Identity Theft Affidavit form serves as a crucial tool for individuals who have fallen victim to identity theft. This voluntary form streamlines the process of reporting incidents to law enforcement and disputing fraudulent charges with credit reporting agencies and creditors. Completing the form typically takes around ten minutes and requires victims to provide personal information, including their full legal name, date of birth, and Social Security number. Additionally, it prompts users to place a fraud alert on their credit reports and to review them for any signs of tampering. The affidavit also includes sections for detailing the fraudulent activities, identifying any suspects, and documenting the specific accounts affected. By collecting essential information about the crime, the form facilitates the creation of an Identity Theft Report, which can significantly expedite the blocking of fraudulent information from credit reports. For those seeking a more secure method, the FTC offers an online version of the affidavit that can be printed for personal records. Overall, the FTC Identity Theft Affidavit is an essential first step for victims in reclaiming their identity and addressing the repercussions of identity theft.

Ftc Identity Theft Affidavit Preview

Leave (3)

blank until

you provide

this form to

someone with

a legitimate

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.

Skip (8) - (10)

if your

information

has not

changed since

the fraud.

Now

About You (the victim)

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:

Place a fraud alert on your credit reports, and review the reports for signs of fraud.1.

Close the accounts that you know, or believe, have been tampered with or opened fraudulently.2.

(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 Name Apartment, 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: ______________________________________

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.

_______________________________________________________________

City State Zip Code Country

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.

Average time to complete: 10 minutes

(10) My daytime phone: (____)_________________ My evening phone: (____)_________________

My email: _____________________________________

(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.

(14) I believe the following person used my information or identification

documents to open new accounts, use my existing accounts, or commit other

fraud.

Victim’s Name _______________________________ Phone number (____)_________________ Page 2

Declarations

About You (the victim) (Continued)

(14):

Enter what

you know

about anyone

you believe

was involved

(even if you

don’t have

complete

information).

Name: ___________________________________________________

First Middle Last Suffix

Address: __________________________________________________

Number & Street Name Apartment, Suite, etc.

__________________________________________________________

City State Zip Code Country

Phone Numbers: (____)_______________ (____)________________

Additional information about this person: _____________________________________

_______________________________________________________________________

About the Fraud

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):

________________________________________________________________

______________________________________________________________________________

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) __________________________________________________________________________

(18) Credit inquiries from these companies appear on my credit report as a result of this identity

theft:

Company Name: _______________________________________________________________

(14) and (15):

Attach

additional

sheets as

needed.

(16): Reminder:

Attach copies

of your identity

documents

when sending

this form to

creditors

and credit

reporting

agencies.

(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).

Documentation

___________________________________________________________________

Name of Institution Contact 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 Institution Contact 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 Institution Contact 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 ($)

Victim’s Name _______________________________ Phone number (____)_________________ Page 4

(19) Below are details about the different frauds committed using my personal information.

(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

(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 Department State

____________________________ _____________________

Report Number Filing Date (mm/dd/yyyy)

____________________________________________________________________

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): ________________________

Your Law Enforcement Report

(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:

A law

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.

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)

Signature

(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

Your Affidavit

Victim’s Name _______________________________ Phone number (____)_________________ Page 6

↓ Ftc Identity Theft Affidavit

File Properties

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 voluntary and serves 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 completing the form, victims should place a fraud alert on their credit reports and review them for signs of fraud.
Documentation Requirement	Victims must attach copies of identity documents when submitting the form to creditors and credit reporting agencies.
Law Enforcement Report	Filing a law enforcement report can help block identity theft-related information from appearing on credit reports.

Instructions on Utilizing Ftc Identity Theft Affidavit

Filling out the FTC Identity Theft Affidavit form can be a crucial step in addressing identity theft issues. Once completed, this affidavit will help you file a report with law enforcement and dispute any fraudulent activities with credit reporting agencies and creditors. Here’s a straightforward guide to assist you in filling out the form accurately.

Gather Necessary Information: Collect your personal information, including your full legal name, date of birth, Social Security number, driver’s license number, and current address.
Provide Your Contact Details: Fill in your daytime and evening phone numbers and email address. Leave the three blank fields for your Social Security number and email until you provide this form to a legitimate business need.
Fill Out Your Information at the Time of Fraud: If your information changed during the fraud, include your full legal name, address, daytime and evening phone numbers, and email address at that time.
Complete the Declarations Section: Indicate whether you authorized anyone to use your information, if you received any benefits from the fraud, and if you are willing to cooperate with law enforcement.
Describe the Fraud: Provide details about the person you believe used your information and any documents they used to commit fraud. Include additional information about the crime, such as how the thief accessed your information.
Verify Your Identity: List the documents you can use to verify your identity, such as a government-issued photo ID or proof of residency.
Identify Inaccurate Information: Specify any inaccurate personal information on your credit report due to identity theft, along with the names of companies that made inquiries on your report.
Detail Fraudulent Accounts: For each fraudulent account, provide the name of the institution, contact person, account number, type of account, and dates when the fraud occurred and was discovered.
Law Enforcement Report: Indicate whether you have filed a law enforcement report, and provide the details of the report if applicable. Ensure an officer witnesses your signature.

After completing the form, make sure to attach any necessary documentation that supports your claims. This may include copies of your identification and any correspondence related to the identity theft. You are now ready to submit your affidavit to the relevant authorities and take steps toward resolving the issues caused by identity theft.

Important Facts about Ftc Identity Theft Affidavit

What is the FTC Identity Theft Affidavit form used for?

The FTC Identity Theft Affidavit form is a voluntary document designed for individuals who have experienced identity theft. It serves multiple purposes: it can be used to file a report with law enforcement and to dispute fraudulent activities with credit reporting agencies and creditors. By completing this form, victims can provide essential information about the identity theft incident, helping to establish a clear record of the fraud and facilitating the resolution process.

How long does it take to complete the FTC Identity Theft Affidavit form?

Typically, individuals can expect to spend about 10 minutes filling out the FTC Identity Theft Affidavit form. This timeframe allows enough opportunity to gather necessary information, such as personal details and specifics about the fraudulent activities. Taking the time to accurately complete the form can significantly aid in resolving issues related to identity theft.

What steps should I take before completing the affidavit?

Before filling out the FTC Identity Theft Affidavit form, it's important to take certain preliminary steps. First, place a fraud alert on your credit reports to notify creditors of potential identity theft. Next, review your credit reports for any signs of fraudulent activity. If you identify any accounts that have been tampered with or opened fraudulently, close those accounts immediately. These actions help protect your financial information and can streamline the process of reporting the theft.

What kind of documentation do I need to provide with the affidavit?

When submitting the FTC Identity Theft Affidavit, you will need to provide documentation that verifies your identity. This can include a valid government-issued photo ID, such as a driver’s license or passport. If you are under 16 and lack a photo ID, a copy of your birth certificate or official school record can suffice. Additionally, include proof of residency during the time the disputed charges occurred, such as utility bills or rental agreements. It's crucial to attach copies of these documents when sending the form to creditors and credit reporting agencies.

How can I obtain a law enforcement report to support my affidavit?

To obtain a law enforcement report, visit your local law enforcement office with the completed FTC Identity Theft Affidavit and any supporting documentation. Request that an officer witness your signature and complete the necessary information in the affidavit. It’s vital to secure a report number, regardless of whether you file the report in person or receive a copy of the official document. This report will be essential for disputing fraudulent information with credit reporting agencies.

Common mistakes

Filling out the FTC Identity Theft Affidavit form can be a daunting task, and mistakes can easily happen. One common error is not placing a fraud alert on credit reports before filling out the form. This step is crucial as it alerts credit reporting agencies and creditors that your identity may have been compromised. By skipping this step, individuals may miss out on additional protections that can prevent further fraudulent activity.

Another frequent mistake is failing to provide accurate personal information. It’s essential to ensure that your full legal name, Social Security number, and address are correct. Inaccuracies can lead to delays in processing your report and may complicate your efforts to resolve any identity theft issues. Double-checking this information before submission can save time and prevent frustration later on.

Many people also overlook the importance of documenting all relevant details about the fraud. In the section where you describe how the identity thief gained access to your information, it’s vital to provide as much detail as possible. This includes listing any documents used or how the fraud occurred. Insufficient information can hinder law enforcement's ability to investigate and may affect your ability to recover losses.

Lastly, forgetting to attach necessary documentation is a mistake that can significantly impact the outcome of your case. When submitting the affidavit, it’s important to include copies of your identification and any proof of residency. Failing to do so may result in your report being rejected or delayed. Always ensure that you have all required documents ready before sending in your form.

Documents used along the form

The FTC Identity Theft Affidavit form is a crucial document for individuals who have experienced identity theft. It helps victims report the crime and dispute fraudulent activities with creditors and credit reporting agencies. In addition to this affidavit, several other forms and documents are commonly used in the identity theft recovery process. Below is a list of these documents, along with brief descriptions of each.

Identity Theft Report: This report is generated by law enforcement when you file a complaint about identity theft. It serves as official documentation of the crime and can help you dispute fraudulent charges.
Fraud Alert Request: A request to place a fraud alert on your credit report. This alert notifies creditors to take extra steps to verify your identity before opening new accounts.
Credit Report Dispute Form: A form used to dispute inaccuracies on your credit report. This helps ensure that any fraudulent information is corrected or removed from your credit history.
Credit Freeze Request: A request to freeze your credit report. This prevents new creditors from accessing your credit report, making it harder for identity thieves to open accounts in your name.
Affidavit of Forgery: This affidavit is used when you need to report forged signatures or documents. It provides a sworn statement regarding the forgery and can support your claims with financial institutions.
Police Report: A formal report filed with law enforcement detailing the identity theft incident. This document can be essential for proving your case to creditors and credit reporting agencies.
Victim’s Statement: A written account from the victim detailing the events surrounding the identity theft. This statement can provide additional context and support for your claims.
Account Closure Request: A request to close any accounts that have been compromised. This document helps ensure that no further fraudulent activity can occur on those accounts.

These documents are essential tools in the fight against identity theft. They help victims reclaim their identity and restore their financial standing. It is important to gather and complete these forms carefully to facilitate the recovery process.

Similar forms

Identity Theft Report: This document serves as an official record of identity theft, which can be used to support claims with credit reporting agencies and creditors. Like the FTC Identity Theft Affidavit, it requires detailed information about the victim and the fraudulent activities that occurred.
Fraud Affidavit: A fraud affidavit is a sworn statement that details fraudulent activities and is often used to dispute charges with financial institutions. Similar to the FTC form, it requires the victim to provide personal information and specifics about the fraud.
Credit Dispute Letter: This letter is sent to credit reporting agencies to dispute inaccuracies on a credit report. It shares similarities with the FTC Identity Theft Affidavit in that both require documentation of identity theft and the inaccuracies being reported.
Police Report: A police report is filed with law enforcement when a crime, such as identity theft, occurs. Like the FTC Identity Theft Affidavit, it documents the victim's account of the crime and is often necessary for further actions with creditors and credit bureaus.

Dos and Don'ts

When filling out the FTC Identity Theft Affidavit form, it’s essential to be thorough and accurate. Here are five important things to keep in mind, including what to do and what to avoid.

Do: Place a fraud alert on your credit reports before completing the form. This step helps protect your accounts.
Do: Review your credit reports for any signs of fraudulent activity. This will help you provide accurate information.
Do: Include your full legal name and all relevant contact information. This ensures that the authorities can reach you if needed.
Do: Attach copies of supporting documents, such as your ID and proof of residency, when submitting the form. This strengthens your case.
Do: Keep a copy of the completed affidavit for your records. This can be useful for future reference.

Don't: Leave any sections blank, especially your personal information. Incomplete forms may delay processing.
Don't: Provide inaccurate or false information. This can hinder your case and may lead to further complications.
Don't: Skip documenting all instances of fraud. Provide details for each incident to give a complete picture.
Don't: Forget to check the validity of your law enforcement report number. Ensure you have this before submitting your affidavit.
Don't: Assume that the affidavit alone will resolve all issues. Follow up with creditors and law enforcement as necessary.

Misconceptions

Here are six common misconceptions about the FTC Identity Theft Affidavit form:

It is mandatory to use the FTC Identity Theft Affidavit form. Many believe that using this specific form is required for all cases of identity theft. In reality, while it is a helpful tool, it is not mandatory. Victims can report identity theft in other ways.
The form guarantees immediate resolution of the issue. Some think that filling out the affidavit will instantly solve their identity theft problems. However, this form serves as a starting point for reporting and disputing issues, but it does not ensure immediate action or resolution.
Only law enforcement can file the affidavit. There is a misconception that only police officers or law enforcement can submit this affidavit. In fact, victims can complete and submit the form themselves to initiate the reporting process.
Filing the affidavit is enough to clear your credit report. Many believe that submitting the affidavit alone will remove fraudulent charges from their credit reports. While it helps in disputing inaccuracies, victims must also follow up with credit reporting agencies to ensure corrections are made.
You must have all details about the fraud to complete the form. Some think they need comprehensive information before filling out the affidavit. However, it is acceptable to provide as much information as available, even if it is incomplete or estimated.
The affidavit is only for recent fraud cases. Another misconception is that the affidavit can only be used for current incidents of identity theft. In reality, it can be used for any past incidents as well, helping victims to address ongoing issues related to previous fraud.

Key takeaways

Key Takeaways for Filling Out the FTC Identity Theft Affidavit Form:

The form is designed to help victims report identity theft to law enforcement and dispute issues with credit agencies and creditors.
Before filling out the form, it's crucial to place a fraud alert on your credit reports and review them for any signs of fraud.
Make sure to provide accurate personal information and any details about the fraud, including how your information was accessed.
Attach necessary documentation, such as a government-issued ID and proof of residency, when submitting the form to creditors or credit reporting agencies.