Sworn affidavit for victims of identity theft to report fraudulent accounts, transactions, and debts to creditors, collectors, and credit bureaus. Based on the FTC Identity Theft Affidavit format.
The Identity Theft Affidavit (FTC) is a ready-to-use legal & compliance template you can send for signature in minutes. It is written for 1 signer (victim) and, by default, expires 30 days after it is sent if left unsigned. It covers identity theft, ftc, affidavit, fraud, credit, consumer protection. Like every Abundera Sign template it is a convenience draft structured for ESIGN Act and UETA compliance, not a substitute for legal advice. Each signed copy is sealed with PAdES-LTA digital signatures, dual RFC 3161 timestamps, and a tamper-evident evidence package in WORM storage.
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# Identity Theft Affidavit (FTC) This affidavit is submitted pursuant to the Federal Trade Commission's prescribed Identity Theft Affidavit format and applicable provisions of the Fair Credit Reporting Act (15 U.S.C. § 1681 et seq.), the Fair Debt Collection Practices Act (15 U.S.C. § 1692 et seq.), and the Identity Theft Enforcement and Restitution Act (18 U.S.C. § 1028). Creditors and consumer reporting agencies are advised that this affidavit constitutes written notification of identity theft as contemplated by 15 U.S.C. § 1681c-2. --- ## Section 1 — Victim Information Full Legal Name: ___________ Date of Birth: ___________ Current Address: ___________ Phone Number: ___________ Email Address: ___________ Social Security Number (last four digits only): ___________ Driver's License / State ID Number: ___________ Issuing State: ___________ --- ## Section 2 — Identity Theft Description I discovered that my identity was stolen on or around: ___________ I believe the theft occurred on or around: ___________ I believe the theft occurred in (City, State, or Online): ___________ Describe how you discovered the identity theft: ___________ Describe what you believe the thief did with your personal information: ___________ I have reason to believe the identity theft was committed by (check all that apply):