MASTER - NO NOTARY ACR FORM AFFIDAVIT 04-01-21

MASTER, -, NO, NOTARY, ACR, FORM, AFFIDAVIT, 04-01-21

• Browser built in viewer
• PDF Viewer
• Universal Document Viewer
• Google Docs View
• Google Drive View
• Download Document [pdf]
Not Your Device? Search For Manuals / Datasheets:



File Info : application/pdf, 5 Pages, 178.37KB

Document Document

ACCOUNT CHANGE REQUEST FORM Please Print or Type

CURRENT ACCOUNT HOLDER

NEW ACCOUNT HOLDER

Name:_____________________________ Address:___________________________ City, State, Zip:______________________ Best Contact #:______________________ Account Number:_____________________ Email Address:_______________________

Name: _____________________________ Address:____________________________ City, State, Zip:_______________________ Best Contact #:_______________________ Account Number:_____________________ Email Address:_______________________

Step 1: Select the reason for the request: Account holder is deceased Military deployment Transfer Account to New Account Holder
(do not use for death of a customer)
Legal name change Name change ­ divorce/marriage Account holder is incarcerated Account holder is incapacitated

Step 2: Select the change you would like to make:
Disconnect this account on ____/_____/_____
(Please specify date to disconnect)
Please select ONE of the below - Refund Check Payable to:
 Account Holder's Name  "The Estate of" the Account Holder
Transfer this account to a new account holder
(includes equipment and/or access to email and voice mail)
Name Change: ________________________
(Please specify)
Add Manager (i.e. military deployment, incarceration, power of attorney, incapacitation)

Step 3: Using the option that you selected in Step 1 please submit this form and determine the additional documentation you will need to submit with this request below:

Reason For Request Account Holder is Deceased
(Disconnect or Transfer to New Account Holder)
Military Deployment Transfer Account to New Account Holder (Do not use for death of a customer) Legal Name Change Name Change - Divorce Name Change - Marriage
Incarceration Incapacitated

Documentation Needed
 Copy of the death certificate; OR  Valid Government issued picture identification AND Xfinity Affidavit for Deceased Customer
(not required if death certificate is supplied)
 Active Duty Deployment Paperwork; AND  Letter signed by the account holder authorizing you to act on their behalf and make
changes to their Xfinity account; OR  If the service member is unavailable due to deployment, a Power of Attorney authorizing
you to make transactions on behalf of the service member.
 Consent to Transfer Account Form filled out by current and new account holders; AND  Valid Government issued picture identification (driver's license, passport, etc.)  Copy of court order granting your name change  Copy of divorce decree granting your name change; OR  Copy of driver's license or other government issued identification with your new name  Copy of marriage license; OR  Copy of driver's license or other government issued identification with your new name  Proof of Incarceration; AND  Letter signed by the account holder authorizing you to act on their behalf and make
changes to their Xfinity account; OR  Power of Attorney authorizing you to make transactions on behalf of the account holder  Court order naming you as the guardian or conservator for the account holder

XFINITY AFFIDAVIT FOR DECEASED CUSTOMER (not required if death certificate is supplied)

I _______________________________, being duly sworn according to law, declare that I am the [spouse]

[next of kin] [executor or administrator of the estate] (Circle one) of___________________________________

("Decedent") who died on or about the

day of

, 20__.

Fill In One Option Below

[I request that Comcast disconnect Comcast account #_____________________for service at _______________________ (Address) ________________ (City), ________________ (State) _____________ (Zip Code). The final bill should be sent to _______________________ (Address) ________________ (City), ________________ (State) _____________ (Zip Code).]

OR

[I request that Comcast transfer Comcast account #__________________ for service at _______________________________(Address) ________________(City), ________________ (State)_____________(Zip Code) to my name.

If applicable, I certify that I am authorized to view or hear any messages left in the Decedent's Xfinity Digital Voice voicemail box, receive call detail records or view emails left in the Decedent's Xfinity Internet email account.

I am accepting assignment of all Comcast owned equipment currently listed on the account and/or any Xfinity agreements entered into by the current account holder, including, but not limited to, Xfinity Mobile agreements, Xfinity Home agreements or minimum term agreements. I have reviewed these agreements and understand the term agreement may be up to 24 months in length and include early termination fees. I understand if there is Comcast owned equipment that I no longer wish to use with the Xfinity services it is my obligation to return the equipment to Comcast. I agree to be bound by the Comcast Agreement for Residential Services (https://www.xfinity.com/Corporate/Customers/Policies/SubscriberAgreement).

For accounts with Xfinity Mobile, I agree to be bound by by the Xfinity Mobile Customer Agreement (https://www.xfinity.com/mobile/policies/customer-agreement

For accounts with Xfinity Home, I agree to be bound by the Xfinity Home Agreement, (https://www.xfinity.com/secureagreement). I accept the account elections made by the current account holder including, but not limited to, paperless billing, notifications and marketing preferences and understand how to change the elections.

It is my responsibility to change the Xfinity account passwords and/or remove users from the account if I don't want others to have access to the Xfinity account. . I have reviewed the Comcast Customer Privacy Notice (https://www.xfinity.com/Corporate/Customers/Policies/CustomerPrivacy)

If I have Xfinity Voice. I understand and acknowledge that in order for 911 calls to be properly directed to emergency services, Comcast must have my correct service address. If I move my Xfinity Voice equipment to a different address without Comcast's approval, 911 calls may be directed to the incorrect emergency authority with the incorrect address, and my phone service, including 911, may fail. If there is an electrical power outage in my home, calling, including calls to 911, may be unavailable. Calls to 911 may not be completed if there is a

technical or other problem with Comcast's network or other network facilities or databases used to complete 911 calls.
I agree to RELEASE, INDEMNIFY, AND HOLD HARMLESS Comcast, its subsidiaries, affiliates, their respective parents, officers, employees, agents, successors and assigns from and against any claims, demands, actions, liens, rights, subrogated or contribution interests, debts, liabilities, judgments, costs, and attorney's fees, arising out of the this change of account status.

Dated at

,

{City}

Signature

Print Name

Address

Current Account Holder Name

{State}

this day of

, 20 .

_______________________ Telephone
_______________________ Account Number

XFINITY CONSENT TO TRANSFER ACCOUNT (THIS FORM MUST BE COMPLETED BY BOTH THE CURRENT XFINITY ACCOUNT HOLDER AND THE NEW XFINITY ACCOUNT HOLDER)
Current Account Holder Only:
I _______________________________, being duly sworn according to law, give my consent to transfer my Comcast account #_____________________________ for service at ________________________(Address) _________________________ (City) _________________ (State) ___________________(Zip Code) to ___________________________ (Name of the person you want to transfer to) and can be reached at _________________________(Phone Number).
I acknowledge and understand that this consent includes my consent for Comcast to transfer my Xfinity services, equipment, my Xfinity Voice number, voicemail box, call detail records, Xfinity emails and email addresses and if applicable, any deposits.
I acknowledge if I elected automatic payments or I stored a payment instrument on My Account, that it is my responsibility to remove the stored payment instrument before the account is transferred.
I acknowledge and understand that unless and until the transfer is completed that I remain liable for the Xfinity equipment and any charges associated with the Xfinity services on my account, including, but not limited to early termination fees. Further, I acknowledge that I am responsible for returning any Comcast equipment that is not transferred to the new Comcast account holder. My forwarding address will be ___________________________(Address) _____________________(City) ____________________________(State) __________________(Zip).
I agree to RELEASE, INDEMNIFY, AND HOLD HARMLESS Comcast, its subsidiaries, affiliates, their respective parents, officers, employees, agents, successors and assigns from and against any claims, demands, actions, liens, rights, subrogated or contribution interests, debts, liabilities, judgments, costs, and attorney's fees, arising out of the this transfer of account.

Dated at

{City}

,
{State}

Current Account Holder Signature
__________________________________ Current Account Holder Print Name

this day of

, 20 .

New Account Holder Only:
I acknowledge and agree by signing below that:
 If I have Xfinity Voice, I understand and acknowledge that in order for 911 calls to be properly directed to emergency services, Comcast must have my correct service address. If I move my Xfinity Voice equipment to a different address without Comcast's approval, 911 calls may be directed to the incorrect emergency authority with the incorrect address, and my phone service, including 911, may fail. If there is an electrical power outage in my home, calling, including calls to 911, may be unavailable. Calls to 911 may not be completed if there is a technical or other problem with Comcast's network or other network facilities or databases used to complete 911 calls.
 I am accepting assignment of all Comcast owned equipment currently listed on the account and/or any Xfinity agreements entered into by the current account holder, including, but not limited to, Xfinity Mobile agreements, Xfinity Home agreements or minimum term agreements. I have reviewed these agreements and understand the term agreement may be up to 24 months in length and include early termination fees. I understand if there is Comcast owned equipment that I no longer wish to use with the Xfinity services it is my obligation to return the equipment to Comcast.
 I accept the account elections made by the current account holder including, but not limited to, paperless billing, notifications and marketing preferences and understand how to change the elections.
 It is my responsibility to change the Xfinity account passwords and/or remove users from the account if I don't want others to have access to the Xfinity account. .
 I agree to be bound by the Comcast Agreement for Residential Services (https://www.xfinity.com/Corporate/Customers/Policies/SubscriberAgreement).
 For accounts with Xfinity Mobile, I agree to be bound by the Xfinity Mobile Customer Agreement (https://www.xfinity.com/mobile/policies/customer-agreement
 For accounts with Xfinity Home, I agree to be bound by the Xfinity Home Agreement, (https://www.xfinity.com/secureagreement).
 I have reviewed the Comcast Customer Privacy Notice (https://www.xfinity.com/Corporate/Customers/Policies/CustomerPrivacy)
I understand that certain Xfinity services including, but not limited to Xfinity Mobile, may require a credit check to determine if I meet the credit requirements for those services. I consent to a credit check by Comcast using the information I provided.

Dated at

{City}

,
{State}

New Account Holder Signature

Print Name

Address

Current Account Holder Name

this day of

, 20 .

_______________________ Telephone
_______________________ Account Number