Items marked with a diamond ♦ are required fields.
Nature of Report
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Select the nature of your report: Cox Business Account Verification Verifying My Identity or Residence For Cox Identity Theft Claim Victim of Unauthorized Mobile Charges/Changes Mobile Device Lost or Stolen In Transit/Never Received
Select One
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Are you an Individual seeking service on behalf of your Employer or are you a Business Owner?
Individual on behalf of the business Business Owner
Select One
Here is what you need to submit this report…..
Guidance
The purpose of this form is to report unauthorized Cox Mobile purchases, or service charges, mobile changes on your account, or unauthorized Cox Mobile purchases using your bank or credit card information. If there has been an unauthorized purchase of a Cox Mobile device on your account using Cox Mobile’s device financing vendor Citizens, please contact Citizens directly at 1-877-291-6391.
Item #1
1) Unauthorized Cox Mobile Charges/Affidavit:
Completion of this form in its entirety will suffice for this requirement. An identity theft affidavit from the Federal Trade Commission is also acceptable and can be attached.CA Residents ONLY: a DMV Investigative Report is also acceptable and can be attached.
Item #2
2) Proof of Identity:
You MUST include a legible copy of TWO of the following government issued photo IDs:
Driver’s License
State Identification Card
Passport
Item #3
3) Proof of Residency:
If you were a minor when the COX account was open, a copy of your birth certificate is needed.
In all other cases, you must provide TWO (2) items from the list below proving your residency while the COX account was opened.
Please include copies of ANY TWO (2) items listed below.
Local Utility Bill (Gas, Power, Water) or Letter of Service from a local utility company.
Mortgage or Lease Agreement (Must include dates – rental receipts are not acceptable).
Bank or other financial statements with your name and home address listed.
Pay Stub or letter on official company letterhead from your Human Resources department.
Item #4
4) Police Report:
An actual copy of the Police Report, requested by you, to report the initial theft of your identity.
Item #5
5) Notary affidavit
Print this notary form and sign in front of a notary public. Have the form notarized and attach it to the File Upload section below.
Additional Resources
Additional Resources
If your claim is approved, you will receive a letter explaining your release from this debt and its removal from collections and your credit. Claims take approximately 7-10 business days to process. The credit bureaus take approximately 45-90 days (depending when each bureau updates their records) to clear and remove this collection from your credit.
Website
Phone Number
Mailing Address
Free copies of your Credit Report
www.annualcreditreport.com 1.877.322.8228
P.O. Box 105281 Atlanta, Georgia 30348
Social Security Admin. Fraud Hotline
http://www.ssa.gov/ Phone:
P.O. Box 17768
Opt-Out of Pre-Approved Offers
www.optoutprescreen.com 1.888.5OptOut
Optoutprescreen.com
Direct Marketing Association Opt-Out
https://www.dmachoice.org/MPS Direct Marketing Association
Guidance
The purpose of this form is to report unauthorized Cox Mobile purchases, service charges, Mobile changes on your account, or Cox Device Payment Plan. (Note: If there has been an unauthorized purchase of a Cox Mobile device on your account using Cox Mobile’s device financing vendor Citizens, please contact Citizens directly at 1-877-291-6391.)
Item #1
1) Unauthorized Cox Mobile Charges/Affidavit:
Completion of this form in its entirety will suffice for this requirement. An identity theft affidavit from the Federal Trade Commission is also acceptable and can be attached.CA Residents ONLY: a DMV Investigative Report is also acceptable and can be attached.
Item #2
2) Proof of Identity:
You MUST include a copy of at least ONE of the following government issued IDs (additional documents may be requested):
Driver’s License
State Identification Card
Passport
Military Identification
Item #3
3) Proof of Residency:
If you were a minor when the COX account was open, a copy of your birth certificate is needed.
In all other cases, you must provide ONE (1) items from the list below proving your residency while the COX account was opened (additional documents may be requested):
Please include copies of ANY ONE (1) items listed below.
Local Utility Bill (Gas, Power, Water) or Letter of Service from a local utility company.
Mortgage or Lease Agreement (Must include dates – rental receipts are not acceptable).
Bank or other financial statements with your name and home address listed.
Pay Stub or letter on official company letterhead from your Human Resources department.
Item #4
4) Police Report (Optional):
An actual copy of the Police Report, requested by you, to report the initial theft of your identity is required. The report will be reviewed along with the other documents attached.
Additional Resources
Additional Resources
If your claim is approved, you will receive a letter explaining your release from this debt and its removal from collections and your credit. Claims take approximately 7-10 business days to process. The credit bureaus take approximately 45-90 days (depending when each bureau updates their records) to clear and remove this collection from your credit.
Website
Phone Number
Mailing Address
Free copies of your Credit Report
www.annualcreditreport.com 1.877.322.8228
P.O. Box 105281 Atlanta, Georgia 30348
Social Security Admin. Fraud Hotline
http://www.ssa.gov/ Phone:
P.O. Box 17768
Opt-Out of Pre-Approved Offers
www.optoutprescreen.com 1.888.5OptOut
Optoutprescreen.com
Direct Marketing Association Opt-Out
https://www.dmachoice.org/MPS Direct Marketing Association
Guidance
The two (2) items listed below are required for your Identity Theft Claim. Please attach both items in the File Upload section below. Both items must be attached for your Identity Theft Claim.
Item #1
1) Proof of Identity:
You MUST include a copy of at least ONE of the following government issued IDs (additional documents may be requested):
Driver’s License
State Identification
Military Identification
Passport
SSN Card
Item #2
2) Proof of Residency:
If you were a minor when the COX account was open, a copy of your birth certificate is needed.
In all other cases, you must provide ONE (1) items from the list below proving your residency while the COX account was opened (additional documents may be requested):
Please include copies of ANY ONE (1) items listed below.
Local Utility Bill (Gas, Power, Water) or Letter of Service from a local utility company.
Mortgage or Lease Agreement (Must include dates – rental receipts are not acceptable).
Bank or other financial statements with your name and home address listed.
Pay Stub or letter on official company letterhead from your Human Resources department.
Additional Resources
Additional Resources
If your claim is approved, you will receive a letter explaining your release from this debt and its removal from collections and your credit. Claims take approximately 7-10 business days to process. The credit bureaus take approximately 45-90 days (depending when each bureau updates their records) to clear and remove this collection from your credit.
Website
Phone Number
Mailing Address
Free copies of your Credit Report
www.annualcreditreport.com 1.877.322.8228
P.O. Box 105281 Atlanta, Georgia 30348
Social Security Admin. Fraud Hotline
http://www.ssa.gov/ Phone:
P.O. Box 17768
Opt-Out of Pre-Approved Offers
www.optoutprescreen.com 1.888.5OptOut
Optoutprescreen.com
Direct Marketing Association Opt-Out
https://www.dmachoice.org/MPS Direct Marketing Association
Guidance
The two (2) items listed below are required to verify your identity. Please attach both items in the File Upload section below. Both items must be attached to verify your identity.
Item #1
1) Proof of Identity – Individual:
If you are an Individual seeking service on behalf of the Business, include a copy of ONE of the following items from Group 1 below:
Group 1 – Principal ID:
State issued Driver’s License
Valid (non-expired) Passport
State issued ID card
Military ID
Item #1
1) Proof of Identity – Business Owner:
If you are a Business Owner, include a copy of ONE of the following items from both Group 1 AND Group 2:
Group 1 – Business ID:
Business License
Secretary of State Registration
Group 2 – Principal ID:
State issued Driver’s License
Valid (non-expired) Passport
State issued ID card
Military ID
Item #1
1) Proof of Identity:
You MUST include a copy of at least ONE of the following government issued IDs (additional documents may be requested):
Driver’s License
State Identification
Military Identification
Passport
SSN Card
Item #2
2) Proof of Residency:
You MUST provide ONE of the following items (additional document may be requested):
Current Utility Bill
Property Deed
Lease Agreement
Guidance
The purpose of this form is to report a Cox Mobile device purchase that was not received by the Customer when delivered by the third-party carrier or lost in transit/stolen.
Item #1
1) Proof of Identity:
You MUST include a copy of at least ONE of the following government issued IDs (additional documents may be requested):
Driver’s License
State Identification Card
Passport
Military Identification
Item #2
2) Police Report (Required):
An actual copy of the Police Report, requested by you, to report the initial theft of your device(s). The report will be reviewed along with the other documents attached.
Additional Resources
Additional Resources
If your claim is approved, you will receive a letter explaining your release from this debt and its removal from collections and your credit. Claims take approximately 7-10 business days to process. The credit bureaus take approximately 45-90 days (depending when each bureau updates their records) to clear and remove this collection from your credit.
Website
Phone Number
Mailing Address
Free copies of your Credit Report
www.annualcreditreport.com 1.877.322.8228
P.O. Box 105281 Atlanta, Georgia 30348
Social Security Admin. Fraud Hotline
http://www.ssa.gov/ Phone:
P.O. Box 17768
Opt-Out of Pre-Approved Offers
www.optoutprescreen.com 1.888.5OptOut
Optoutprescreen.com
Direct Marketing Association Opt-Out
https://www.dmachoice.org/MPS Direct Marketing Association
Your Name & Contact Information
♦
Name of Owner of Business
Contact Information for Owner of Business
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Select One
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Last four (4) digits of SSN:
♦
Driver’s license or state identification card number:
Your Location
Alabama Alaska Arizona Arkansas California Colorado Connecticut DC Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Not Applicable
Select One
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Date that you began living at this address:
Format: mm/dd/yyyy
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Date employment with Business began:
Format: mm/dd/yyyy
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Date you established business at this address:
Format: mm/dd/yyyy
♦
Address you were residing in at the time of the theft:
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Date that you began living at your previous address:
Format: mm/dd/yyyy
♦
Date that you stopped living at your previous address:
Format: mm/dd/yyyy
Fraud Details
Person whom you authorized to open a COX account / utilities:
Approximate date these documents were stolen or lost:
Format: mm/dd/yyyy
Do you know who opened this COX account with your personal information?
Yes No
Select One
Provide as much detail as possible regarding this incident / concern:
♦
What state was the disputed account opened in?
Alabama Alaska Arizona Arkansas California Colorado Connecticut DC Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Not Applicable
Select One
On what date was the account created?
Format: mm/dd/yyyy
On what date was the account closed?
Format: mm/dd/yyyy
Claim Details
Provide as much detail as possible regarding this incident / concern:
Police Report
Please include an actual copy of the Police Report, requested by you, to report the initial theft of your identity. Attach any documents to your submission in the “File Upload” section.
Including an actual copy of a Police Report, if filed, to report the initial theft of your identity is optional and is not required to be attached. If you choose to attach the report, it will be reviewed along with your other documents and should be attached with your submission in the “File Upload” section.
Certification
I certify that, to the best of my knowledge and belief, all the information on and attached to this affidavit is true, correct, and complete and made in good faith.
I also understand that this affidavit or the information it contains may be made available to federal, state, and/or local law enforcement agencies for such action within their jurisdiction as they deem appropriate.
By signing this, I acknowledge that I am authorized to act on behalf of the individual and/or business requesting service.
I understand that knowingly making any false or fraudulent statement or representation to the government may constitute a violation of 18 U.S.C. §1001 or other federal, state, or local criminal statutes, and may result in imposition of a fine or imprisonment or both.
Notice
Collection efforts will resume and your Identity Theft Claim will be closed 30 days following your claim if ALL requested documentation is not received. If your claim is APPROVED, you will receive a written documentation from COX explaining your release from this debt and its removal from your credit. If your packet has been received and additional documents have been requested your claim will remain open for 60 days.
File Upload
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Here you must upload files and documents for the company to review that are related to this report.Please note that after you choose your documents using the "Select a File" button, you must click on the "Add File" button to append your documents to the report. Once attaching your documents please submit your report immediately. Failure to do so could cause the attachments to time out and not post to your case.
Add File
Reset file uploads
Required Items
Please confirm that you have uploaded the relevant documentation below:
♦
Identity Theft Dispute Form / Affidavit
Unauthorized Cox Mobile Charges Form/AffidavitCA Residents ONLY: DMV Investigative Form
Police Report
Police Report (Optional)
Police Report (Required)
♦
Please provide as much detail as possible regarding this incident / concern:
Follow-Up
After you submit this report you will be issued a 12-digit “Report Key”. Using this report key, you will be able to access the Follow-Up functionality of this report. COX will reply within 24 – 72 hours advising of the next steps required.
After you submit this report you will be issued a 12-digit Report Key . Using this report key you will be able to access the Follow-Up functionality of this report.
Follow-Up will allow you to:
Upload/Attach documents to this report Respond to follow-up questions/comments Provide additional information
