Separate your line from the account holder

The purpose of this form is to help customers who have experienced domestic violence maintain safe connections with their phone line(s)/number(s).

* Required

Domestic Violence Survivor

Self-Attestation

As a result, I want to move my line(s)/phone number(s) from my current T-Mobile account.

 

If your request is approved, T-Mobile will release you from your current account without fee or penalty. Please note that upon release the Primary Account Holder will receive automatic notification of a change to the account.

Provide your name and phone number:

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.

 

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):

    Domestic Violence Form

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    Signature Form

    Signature Step
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    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.

     

    National Network to End Domestic Violence 

    www.nnedv.org for more information.

     

    Find a local domestic violence shelter near you 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
    • 6-8 digit account PIN

    Additional resources:

     

    National Domestic Violence Hotline

    1-800-799-SAFE (7233) or visit their website at www.thehotline.org.

     

    National Network to End Domestic Violence 

    www.nnedv.org for more information.

     

    Find a local domestic violence shelter near you if you need shelter or any other assistance.