Identity Theft Affidavit Form

June 1, 2011

Date of filling the affidavit form: ______________

IDENTITY THEFT AFFIDAVIT FORM NUMBER: ____________

Legal name of the victimized person: ____________

Signature of the victimized person: ___________

Date of Birth: _______________

Identification proof: ____________

Full contact address: _____________

Contact phone number: ____________

Email: ______________

The details of the fraud citing the specific nature of the identity theft:

______________________________________
The prime suspect of the fraud according to the victimized person: __________________

Other suspect/s (if any): ________________

Reason/s for suspecting the above mentioned person/s:

_____________

Official signature of the administrative personnel overseeing the case (case no: ________

 

Download Identity Theft Affidavit Form In Word Format

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