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IDentity Theft

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					                                               IDentity Theft                                                    is a major problem in America

                                                                                Get the experts on your side




identity theft can go way beyond
credit cards and on-line shopping.
Unlike the majority of identity theft plans available, we’re not go-            Identity Restoration
ing to simply send you a few forms or walk you through the steps                    Identity theft can be devastating, and the process of restoring
of identity restoration.                                                            your name can be overwhelming and costly. You need more
                                                                                    than “do it yourself ” information if it happens to you.
We’re going to do most of the work for you!
                                                                                    With the Identity Theft ShieldSM a trained expert will take
credit report                                                                       the steps to restore your name and credit for you!
    Evaluate your current credit standing with:
    • An up-to-date credit report through Experian                                  • Help reduce your out-of-pocket expenses and time
      at no added cost                                                                spent away from work with valuable services from
    • A personal credit score calculated by                                           detection to resolution
      an independent scoring service
    • A detailed analysis of your personal credit score                             • Our Licensed Investigators will work on your
                                                                                      behalf to help correct identity theft issues you have with
    Experts recommend that you review your credit                                      affected agencies and institutions, including: Credit card
    report regularly. The Identity Theft Shield makes                                  companies, Financial Institutions All three credit repositories,
    it easy.                                                                           Federal Trade Commission, Social Security Administration,
                                                                                       Department of Motor Vehicles, U.S. Postal Service, Law
continuous credit monitoring                                                           enforcement personnel… and other organizations that may
    Suspicious activity will be brought to your attention,                             be affected
    providing you with early detection.
                                                                                    • Fraud alert notifications will be sent on your behalf to all
    You’ll receive prompt notice if the credit repository                              three credit repositories, Social Security administration,
    is notified that:                                                                  Federal Trade Commission, U.S. Postal Service and affected
    • New accounts have been opened in your name                                       credit card companies and financial institutions.
    • Derogatory notations have been added to your
       credit report                                                                • Proactive searches of applicable local and national
    • Public records have been added to your report                                    databases will be made on your behalf to look for
    • Inquiries have been made against your report                                     information you may not be aware of, including:
    • A change of address has been requested                                           criminal activity in your name in your county’s records
                                                                                       and certain federal watch lists, Department of Motor Vehicle
                                                                                       records in your state, unknown addresses affiliated with
What sets us apart from                                                                your name, and banking activity in your name reported as
everything else in the market?                                                         fraudulent

    • If the unthinkable happens to you, you’ll want more than a stan-
      dardized info packet to help you resolve all your issues. Every case is   Identity Restoration will not apply if the identity theft is the result of a dishonest,
      unique, and often countless contacts are necessary. We’ll do most of      criminal, malicious, or fraudulent act you, your spouse, or your child participated in,
      the work for you!                                                         directed, or had knowledge of. Restoration services will not be provided for a known stolen
                                                                                identity event that occurred prior to enrollment date. You must be an active member to
    • Plans generally provide coverage for a specific credit card or bank ac-   receive restoration services. Services are available for pre-existing conditions at a discounted
      count. We help you with all issues related to identity theft, includ-     rate. Services provided do not cover financial losses arising from the identity theft. A signed
      ing issues with:                                                          limited power of attorney must be provided to Kroll when an Identity Theft Restoration
                                                                                case is opened in order for Kroll to work on your behalf and/or provide the Proactive
      • Law enforcement • Health benefit providers                              Database Searches listed. A stolen identity event does not include the theft or unauthorized
      • DMV records          • Employers                                        or illegal use of your business name, d/b/a, or any other method of identifying your
                                                                                business activity.
      • Postal records       • And more...
                                                                                                                                                                                           oFFicE USE oNLY
                                                         SM
                                                                                                                                                                                           CWA
                                                                                                                                                                                           FOB
Benefits provided by: Kroll Background America                    Activating your plan is easy! Choose one of these options:
                                                                  1. Complete the application below                           2. For questions or more information                         MODE
Coverage for you & your spouse                                       • Sign as designated                                        call: Patrice M. Gaul, 610-505-4145
Administered by:                                                     • Return it to Temple University                                                                                      PLAN
Pre-Paid Legal Services®, Inc., and subsidiaries                       Human Resources Department
Corporate Offices: P.O. Box 145 • Ada, OK 74821-0145                   608 University Services Bldg (083-39)                                                                               FRAN
                                                                       1601 N. Broad Street
                                                                       Philadelphia, PA 19122                                                                                              GP#     62768
APPLicATioN
                                          PLEASE PriNT
                                                                                                                  TEmPLE UNivErSiTY APPLicATioN: ofc Use only

                                                                                                                 Franchise Number:         62768
                                                                 If you choose the bank draft option,
Today’s Date                      /              /               your account will be drafted on or              Assigned Associate Number: ______________________________________
                                                                                                                 Associate Name: Farmington                   Adm.
                                                                 about this date each month.
                        Month             Day             Year
                                                                                                                 Business Phone: 610-660-7708
                                  -                 -
                                                                    For internal use only by
SSN #                                                               PPLSI. Our privacy policy                    Signature of Associate ___________________________________________
                                                                    is available upon request.


Name        Last
                                                                                                                 Applicant Agreement: I understand that the written contract sets
                                                                                                                 forth the terms of my membership, including any exclusions or limitations, and agree to be
                                                                                                                 bound by the same. I further understand that the company will mail the written contract to me
                                                                                       MI                        at the address noted herein within the next 20 days. If I have not received my contract within
               First
                                                                                                                 that time frame, I understand that it is my responsibility to call the Pre-Paid Legal Home Of-
                                                                                                                 fice at 1-800-654-7757 to obtain a copy. The written contract, together with this application,
Mailing        Apt. /
               Ste.#
                                                                                                                 constitutes the entire agreement between the company and the member with respect to the
Address                                                                                                          membership, and there are no agreements, understandings, warranties or representations
                                                                                                                 other than as set forth herein and in the membership contract.
               Street
               Address



               City                                                                                               Signature of Applicant X


               State                      ZIP + 4

Member’s                              /              /                                                           Work Phone                             -                    -
Date of Birth             Month            Day            Year

Spouse      Last                                                                                                Home Phone                              -                    -

               First                                                                   MI

                                                                                                        Your privacy is a priority with us! PPLSI will not sell your email address or personal information of any
Email Address                                                                                           kind to third party vendors.


payment information                                                To comPLETE, select the oNE payment option you                                        Please fill out for Draft or
                                                                   prefer. Your credit card charge or check is your receipt.                             credit card payment options:
 monthly Draft
                                                                                                                                                                                             12 95
                                                                                                                                                     Monthly /
        Authorization for Electronic Transfers Drawn by and Payable for Premium: I hereby authorize Pre-Paid Legal                                   charge amount                     $
                                                                                                                                                     [Identity Theft Shield plan]
        Services®, Inc., to charge/draft my checking/savings account from Temple University. This authority is to remain in
        effect until Pre-Paid Legal Services®, Inc., receives written notification from me revoking the authorization.
        Your account will be drafted each month on or about the effective date of your membership.
                                                                                                                                                     Total enclosed by
                                                                                                                                                     check, money order,     $               12 95
                                                                                                                                                     or charged to credit card

        Name of Institution
                                                                                                                  Acct. #

        Institution Address                                                                                       Institution Transit #
                                                                                                                  Acct Holder Signature X

        CITY                                                             STATE                 ZIP
                                                                                                                  Checking Account                            Savings Account
                                                                                                                 (Attach check from account to be drafted.)   (Attach verification.)


                                                                               I wish to pay by credit card until I revoke
 monthly Payment by credit card                                               this authorization in writing.

                                                                                                                        Exp. Date:
  Card #:                                                                                                               (Mo./Yr.)
                                                                                                    MasterCard  Visa
  Cardholder Signature: X                                                                           Discover    AMEX