Identity Theft Questionnaire
| Which of the following best describes the reason for your dispute? | Claim Reason |
|---|---|
| Changes made without my knowledge or consent. | Account Takeover |
| I did not apply for this account. | Fraud Application |
Changes made without my knowledge or consent.
What changes were made or attempted without your knowledge or consent?
When did you learn about this account?
Are you aware of any other accounts that have been opened without your consent?
Yes
No
Is the following information correct? (Information presented is based on the selection(s) under "What changes were made or attempted without your knowledge or consent?")
Yes
No
Would like us to send you a replacement card?
Yes
No
Do you have any additional information to provide about this dispute?
Yes
No
I did not apply for this account.
Have you recently applied for credit from our organization?
How did you learn about the existence of this account?
Other
When did you learn about this account?
Are you aware of any other accounts that have been opened without your consent?
Yes
No
Is the following information correct?
Yes
No
Do you have any additional information to provide about this dispute?
Yes
No
