Personal Freeze Extension

PERSONAL FREEZE EXTENSION

This Personal Freeze Extension (Extension) is submitted by the Consumer identified below to request an extension of an existing security freeze placed on the Consumer's consumer file, account, or record maintained by the recipient named below. By completing and signing this Extension, Consumer certifies the accuracy of the information provided, authorizes the recipient to extend the existing freeze as set forth herein, and accepts the terms and conditions contained in this document.

Consumer Information

Existing Freeze Details

Recipient/Company Name:

Account or Reference Number:

Original Freeze Effective Date:    Current Freeze Expiration Date:

Extension Request

I request that the existing security freeze identified above be extended as follows (select one option and provide requested details):

  Extend the security freeze for an additional months from the current expiration date.

  Extend the security freeze until further written notice by me (extend until rescinded).

  Extend the security freeze until:

Certifications and Authorizations

By signing below, I certify under penalty of perjury that the information provided on this Extension is true and correct to the best of my knowledge. I authorize the recipient named above to process this request to extend the existing security freeze on my account or consumer file and to take such actions as necessary to affect the extension, including verifying identity and existing freeze status.

I acknowledge that a security freeze restricts access to my consumer file for purposes of extending credit, opening accounts, or other uses described by the recipient. I understand that certain existing creditors, government agencies, and other persons may continue to access my consumer file as permitted by applicable rules and that the freeze does not guarantee protection against all forms of identity misuse.

I further acknowledge that the recipient may require reasonable proof of identity prior to processing this request and that I may be required to submit additional documentation. I agree to hold the recipient harmless for actions taken in reasonable reliance on this Extension, except for actions that constitute willful or grossly negligent misconduct.

Revocation, Processing and Notices

This Extension may be revoked or modified by me through a written notice delivered to the recipient. The recipient may require reasonable time to process a revocation or modification request after receipt. The recipient may provide notice of acceptance or denial of this Extension in writing to the addresses or contact details provided above.

If any fee is required by the recipient under its published policies to process an extension, I understand that such fee may be charged in accordance with the recipient's practices. I acknowledge that I should confirm any applicable fee when submitting this request.

Identity Verification (if required)

To assist in verifying my identity, I provide the following identifying information. The recipient may request photocopies of identification documents if necessary.

Acknowledgment

I understand that making a false statement in connection with this Extension may subject me to penalties under law. I understand that this document is an instruction to the recipient and does not, in itself, create new credit accounts or change the terms of any existing contracts except as necessary to extend the security freeze.

Sign Now