Domestic Abuse Line Separation Request FormGoogle Fi is committed to supporting survivors of domestic abuse and helping them maintain critical access to reliable, safe, and affordable connectivity. For you, a loved one, or your designated representative to request a separation of lines—either you and/or individuals in your care from an abuser’s line or an abuser from your line—please file this request. Please ensure all supporting details and documentation is correct. * Required fieldPlease select one of the followingSelect oneI am a survivor looking to leave my abuser's planI am a survivor looking to remove my abuser from my plan Full name of the survivor *Google Fi email of the survivor *Google Fi phone number of the survivor *Full known name of the abuser *Google Fi email of the abuser *Google Fi phone number of the abuser *If a designated representative is assisting with the line separation request, please provide the full name of this individual.Relationship to survivorProof of representationWill the survivor be bringing individuals in their care with them from the plan? *YesNoIf yes, please provide the full names, Google Fi emails, and phone numbers of these individuals and a signed and dated affidavit stating the individual is in the care of the survivor and is a user of the specific line(s) to be separated.Please upload a document that verifies that an individual who uses a line under the shared mobile contract has committed a covered act against the survivor or an individual in the survivor’s care. Such evidence must include: (i) a copy of a signed affidavit from a licensed medical or mental health care provider, licensed military medical or mental health care provider, licensed social worker, victim services provider, or licensed military victim services provider, or an employee of a court, acting within the scope of that person’s employment; or (ii) a copy of a police report, statements provided by police, including military or Tribal police, to magistrates or judges, charging documents, protective or restraining orders, military protective orders, or any other official record that documents the covered act. *Please upload a valid copy of the survivor’s government ID. This may include a state-issued driver’s license, state ID, US passport or passport card, or a Green card. How would you prefer to be contacted regarding this request? If, for some reason, it is unsafe for the survivor to be contacted at the contact information provided above, please let us know what phone/email would be best for us to contact them. *PhoneEmailOtherPlease provide an alternative contact phone number or emailIf you’re the owner of the group plan, you can remove group members from your plan whenever you need. Please note: If you remove a member from your account, the notification to this member will occur immediately after they are removed. Please ensure you are in a safe location when doing this. To remove a group member: Open the Google Fi app or sign in to fi.google.com. Under "Manage plan," select the group member to remove. Select Remove. Each user you remove gets an app notification and email with their Google Fi account transfer info. The member you remove has 60 days to transfer their number to: Another Google Fi plan Google Voice Another provider If the group member doesn’t transfer their number after 60 days, we automatically release their phone number. Do you still need assistance or have questions about Safe Connections Act (47 U.S.C. 345) line separation? *YesNo Full name of the survivor *Google Fi email of the survivor *Google Fi phone number of the survivor *Full known name of the abuser *Google Fi email of the abuser *Google Fi phone number of the abuser *How else can we assist you with this request? *How would you prefer to be contacted regarding this request? If, for some reason, it is unsafe for the survivor to be contacted at the contact information provided above, please let us know what phone/email would be best for us to contact them. *PhoneEmailOtherPlease provide an alternative contact phone number or emailSubmitSubmittedEdit requestDownload submission https://myaccount.google.com/privacypolicy?hl=$0 Some account and system information will be sent to Google, and support calls and chats may be recorded. We will use this information to improve support quality and training, to help address technical issues, and to improve our products and services, subject to our Privacy Policy and Terms of Service. Translation services may be used in chats and email. Additional info OK Your email has been sentThank you for submitting the form. We'll get back to you within the next 24 hours. For your reference, your case ID is $CASE_ID.Edit requestDownload submission