Id Theft Affidavit (Page 7 of 7) in pdf

ID THEFT AFFIDAVIT

Acceptable Forms of Documentation

In order to resolve your disputed claim, you will need to provide one (1) form of identification from Category I (if US citizen)

or Category II (if non US citizen) and two (2) forms of proof of residency from Category III. You may choose from the list of

acceptable documentation below:

Category I—Acceptable forms of identification

Category II—Acceptable forms of identification

for U.S. Citizen

for non U.S. Citizen

• Driver’s License

• Country ID

• State ID

• Driver’s License

• Passport

• Military ID

• Social Security Card

• Passport

• Military ID

• US Immigration and Naturalization Service (INS) department documents:

• Military DD214 Form

•

I-94 (Refugee arrival document) form

• Military Selective Service Card

•

I-688B (Employment Authorization Card)

• Birth Certificate (not a hospital record)

•

I-766 (employment Authorization approval) document

• Native American Reservation ID

•

US Government issued VISA

(Document will state that it is a VISA)

• ID from place of employment

Note: Alien Registration Card is not acceptable.

• Current Student ID

Two (2) separate sources are required as proof of residency from Category III.

Proof of residency documents must cover the entire time period of the disputed charges.

You may choose from the list of acceptable documentation below:

Category III—Proof of Residency

• Mortgage Statement or Title of Ownership

• Local Telephone bill (not a bill from a long distance provider, cellular or

• Official Rental/Lease Agreement

paging company)

• Electric bill

• Home owner’s or renter’s insurance or monthly statements

• Gas bill

• Auto insurance or monthly statements

• Cable bill

• Health insurance or monthly statements (not a medical card)

• Water bill

• Life insurance or monthly statements

• Prison movement documentation

We will not accept rental receipts. The Rental/Lease agreement must be from a management company or owner.

Please return copies of the following to PG&E Fraud Department:

1. Completed copy of pages 1 through 5 of this form

2. Acceptable documentation

3. The report you filed with the police or sheriff’s department

Make sure that your proof of residency covers the entire time period of the disputed charges.

(Service dates located on page 1)

Your affidavit must be signed by a witness that is not a relative, or notarized.

Automated Document

Form 79-858

Preliminary Statement, Part A

Advice 3682-G/4786-E

COT-0815-4378

January 2016

Page 6 of 6

Id Theft Affidavit Page 7

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