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Please note that upon release the Primary Account Holder will receive automatic notification of a change to the account. I am a New York resident. How do you want to separate your T-Mobile account? Create new account Join existing account Provide your name and phone number: First Name Last Name Email Phone number to be released Additional phone number(s) of dependents under your care to be released Add a phone number X Select an optionParentChild Or DependentOther Configuration - Max number of dependent phone numbers Please provide the name of the primary account owner: First Name Last Name __Upload your additional supporting materials\*__ Certain laws require you to provide evidence supporting that you are a victim of domestic violence. We treat this documentation confidentially and securely. For more information on our privacy practices, see our [Privacy Notice](https://www.t-mobile.com/privacy-center/privacy-notices/t-mobile-privacy-notice).   Please provide additional supporting material which may include ANY of the following: - Signed affidavit from (1) licensed medical or mental healthcare provider; (2) victim services provider or (3) employee of court acting within the scope of employment - Court Order - Police report of Police statements provided to Magistrate/judges - Charging documents - Protective or restraining orders - Any other official record that documents the domestic violence Please attach additional information below (__Optional for New York Residents__): Attachments (0) Select a file to uploadMaximum file size allowed is 25MB. Configuration - Maximum Attachment File Count Configuration - Maximum File Size Allowed Text I certify under the penalty of perjury that I have personal knowledge of the facts stated in this Attestation and I have authority to make this Attestation on behalf of myself. I further certify, to the best of my knowledge, all of the statements and representations made in this Attestation are true and correct. I understand that any false statements or misrepresentations could subject me, personally to penalty. If you are experiencing financial hardship , the FCC designated the Lifeline Program, a federal program that lowers the monthly cost of voice or broadband service, to provide 6 months of emergency communications support for eligible qualifying survivors. To see if you qualify please visit [National Verifier (NV) - Universal Service Administrative Company (usac.org)](https://www.t-mobile.com) and [www.lifelinesupport.org](https://www.t-mobile.com) . If you would like more information on the Lifeline Program, please inform the representative on the call. Domestic Violence Form # __Something went wrong. Please try again.__ # Signature Form Signature Step Loading document... # Confirmation Thank you for your submission. A dedicated member of our CARE team will call you to gather more information.  Here’s what you can expect to provide: - New account owner phone number. - Account owner’s verbal consent. __Additional resources:__   __National Domestic Violence Hotline__ __1-800-799-SAFE (7233) or visit their website at [www.thehotline.org](https://www.hotline.org).__   __National Network to End Domestic Violence__  __[www.nnedv.org](https://www.nnedv.org) for more information.__   __Find a local [domestic violence shelter near you](https://www.domesticshelters.org/help#?page=1) if you need shelter or any other assistance.__ # Confirmation Thank you for your submission. A dedicated member of our CARE team will call you to gather more information. Here’s what you can expect to provide: - SSN - Driver’s license number - 6-15 digit account PIN Note: A credit check will be run prior to the new activation. __Additional resources:__   __National Domestic Violence Hotline__ __1-800-799-SAFE (7233) or visit their website at [www.thehotline.org](https://www.thehotline.org).__   __National Network to End Domestic Violence__  __[www.nnedv.org](https://www.nnedv.org) for more information.__   __Find a local [domestic violence shelter near you](https://www.domesticshelters.org/help#?page=1) if you need shelter or any other assistance.__ Clear Form Continue ## Hello! Want to stay logged in? 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