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About You (the victim)
Identity Theft Victims’ 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.
Close the accounts that you know, or believe, have been tampered with or opened fraudulently.
My full legal name: ________________________________________________
My date of birth: __________________
My Social Security number: ________-______-__________
My driver’s license: _________ ___________________
My current street address:
Number & Street Name
Apartment, Suite, etc.
I have lived at this address since ____________________
My daytime phone: (____)___________________
My evening phone: (____)___________________