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FTC Identity Theft Form

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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.

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:

(2) My date of birth: mm/dd/yyyy

(3) My Social Security number:

(4) My driver’s license:

(5) My current street address:

(6) I have lived at this address since

(7) My daytime phone:

My evening phone:

My email:

At the Time of the Fraud

(8) My full legal name was:

(9) My address was:

(10) My daytime phone: My evening phone:

My email:

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

Name:

Address:

Phone Numbers:

Additional information about this person:

(15) Additional information about the crime:

Documentation

A valid government-issued photo identification card (for example, my driver’s license, state-issued ID card, or my passport).

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).

About the Information or Accounts

(17) The following personal information 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:

Company Name:

Company Name:

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

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 ($)

Your Law Enforcement Report

(20) 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

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 No

Victim’s FTC complaint number (if available):

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.

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.

Notary

Witness:

Signature

Printed Name

Date

Telephone Number

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What the FTC Identity Theft Form Is and when it’s used

The FTC Identity Theft Form is a standardized affidavit and incident report used to document identity theft incidents for creditors, financial institutions, and consumer protection purposes. It summarizes the victim’s account of unauthorized transactions, provides factual statements about how personal information was compromised or misused, and authorizes institutions to take remedial steps such as placing fraud alerts, closing accounts, or disabling services. The form supports interactions with banks, credit bureaus, and government agencies and often accompanies dispute letters and police reports when resolving fraudulent activity and restoring a consumer’s credit and accounts.

Why completing an FTC Identity Theft Form matters

Completing the FTC Identity Theft Form creates a concise, documented record of fraud that many creditors and bureaus accept as the consumer’s sworn statement; it can speed investigations and reduce liability exposure for affected accounts.

Why completing an FTC Identity Theft Form matters

Who typically completes and receives the FTC Identity Theft Form

The form is completed by identity theft victims, authorized representatives, or law enforcement when reporting fraud to creditors, credit bureaus, or government agencies.

  • Consumers reporting unauthorized financial transactions or account takeover to banks and card issuers.
  • Victim advocates or attorneys acting with written authorization on behalf of a consumer.
  • Credit reporting agencies and creditors requiring a sworn statement to remove fraudulent accounts.

Keep copies for your records and provide the form to any institution that requests a fraud affidavit to process disputes or place fraud alerts.

Step-by-step completion checklist

Follow these core steps in sequence to complete the form accurately and assemble supporting evidence.

  • 01
    Gather ID: Collect government ID and proof of address.
  • 02
    List incidents: Document unauthorized accounts and dates.
  • 03
    Attach documents: Include bank statements, police report, or correspondence.
  • 04
    Sign and submit: Date and sign the affidavit before sending.

Typical processing flow after submission

Understanding how institutions use the FTC Identity Theft Form helps set expectations for next steps and timing.

  • Submit to Creditor: Creditor receives affidavit and opens fraud investigation.
  • Credit Bureau Notice: Bureaus place fraud alerts or block disputed items.
  • Account Remediation: Institutions close or freeze affected accounts.
  • Follow-up: You receive status updates and next-step instructions.

How to structure an online submission workflow

Use a simple digital workflow to collect signatures, attachments, and verification data for faster processing by creditors and bureaus.

Field Configuration
Identity Upload Permit JPEG/PDF uploads with file size limits
Signature Field Require signer to type and draw signature
Date Field Auto-fill MM/DD/YYYY on signature
Audit Trail Capture IP, timestamp, and device

Key technical considerations for electronic submission

Electronic submissions should maintain document integrity, capture signer intent, and comply with U.S. e-signature law.

  • File formats: PDF, DOCX accepted for records; PDF preferred for fixed layout
  • Authentication: Email or SMS verification to attribute signatures
  • Security: TLS in transit and AES-256 at rest

Platforms that preserve audit trails and support secure uploads reduce disputes and meet evidence requirements for banks and credit bureaus.

Essential sections of a professional FTC Identity Theft Form

A complete affidavit contains specific sections that institutions expect; include each element to avoid processing delays and to substantiate your claim clearly.

Victim Details

Full legal name, current address, date of birth, and SSN when requested; these facts enable matching against account records and credit files.

Incident Summary

A concise chronological account of how the theft occurred, discovery date, and steps you took to mitigate harm, such as contacting issuers.

Accounts Affected

List each account or service with account numbers, dates of unauthorized activity, and amounts to clearly identify items for reversal or dispute.

Supporting Evidence

Attach bank statements, police reports, correspondence, and identity documents to substantiate your narrative and speed creditor investigations.

Affirmation Statement

A declarative clause stating the information is true under penalty of perjury, which many creditors require to accept the affidavit.

Signature Block

Signature, printed name, and date; include notary or witness if the receiving institution or state law requires authentication.

Required data elements often requested

Full name: Your legal name
Address: Street, city, state, ZIP
Date of birth: MM/DD/YYYY
SSN: Full or last four digits
Incident dates: When theft occurred
Account details: Account numbers and amounts

Common mistakes that cause delays

  • Submitting unsigned or undated affidavits that creditors reject.
  • Providing incomplete account numbers or vague descriptions of transactions.
  • Failing to attach police reports or identity documents when requested.
  • Using inconsistent names or addresses that do not match account records.

Risks and consequences of incorrect or false statements

Perjury risk: False statements may lead to criminal penalties
Delayed resolution: Incomplete forms can prolong investigations
Credit impacts: Unresolved fraud can damage credit reports
Account denial: Institutions may deny remediation without proof
Privacy exposure: Sharing unnecessary data increases risk
Legal costs: You may incur attorney fees to resolve disputes

Timing considerations and typical response expectations

Timely submission and follow-up help secure remedies; response times vary by institution but certain consumer protections set expectations for action.

Initial reporting:

Report to issuer and bureaus immediately upon discovery

Creditor response:

Investigations often start within 30–45 days

Credit bureau action:

Bureaus typically investigate and respond within 30 days

Police report filing:

File promptly to support disputes and refunds

Statute of limitations:

Preserve records since civil claims vary by state

Key milestones in the identity-theft remediation timeline

Track these sequential milestones from discovery through closure to confirm each stage is completed and documented.

01

Discovery and documentation

Detect fraud, gather evidence, and note dates and contacts for each incident.

02

File police report

Obtain a police report to support disputes and creditor removals.

03

Submit affidavit

Send the FTC Identity Theft Form and supporting documents to affected institutions.

04

Verification and remediation

Institutions investigate, remove fraudulent items, and restore account access where appropriate.

eSignature vendor comparison for submitting the FTC Identity Theft Form

Compare common pricing and feature criteria for e-signature platforms that support secure affidavit collection; signNow is listed first per platform comparison requirements.

signNow DocuSign Adobe Sign PandaDoc HelloSign
Starting Price $8/user/mo $15/user/mo $14/user/mo $19/user/mo $15/user/mo
Free Trial 7-day free trial Varies Varies Varies Varies
Bulk Send Yes Yes Yes Yes No
Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes Yes Yes No No

Frequently asked questions about the FTC Identity Theft Form

Answers to frequent questions about completion, submission, notarization, and supporting evidence can prevent common rejections and speed remediation.


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