Domestic Abuse Line Separation Request Form

Google 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 linesâ€”either you and/or individuals in your care from an abuserâ€™s line or an abuser from your lineâ€”please file this request.

Please ensure all supporting details and documentation is correct.

* Required field

Please select one of the following

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 survivor

Proof of representation

Will the survivor be bringing individuals in their care with them from the plan? *

If 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 survivorâ€™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 personâ€™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 survivorâ€™s government ID. This may include a state-issued driverâ€™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.

Please provide an alternative contact phone number or email

If youâ€™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 doesnâ€™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? *