A financial connections questionnaire, also called a disassociation form, is a list of questions that you can fill and send to the credit reference agencies if they have outdated or wrong financial association data on your credit report. The questionnaire will ask your name, address history and about the person you want to be financially separated from and your financial connection with this person.

Sample Financial Connections Questionnaire:

1)   Name: _______________________

2)   Any other names that you have been known by: __________

3)   Gender: ______________

4)   Date of Birth: ________________

5)   Phone Number: ________________

6)   Present Address: ____________

7)   How long have you been living at this address?

8)   Please mention your previous addresses in the last 6 years: ______________

9)   How many persons would you like to remove from your credit report?

Please fill the details of the person from who you want to dissociate?

10)                Name: ___________

11)               What is the person’s relationship with you? ___________

12)               Address: _______________

13)               How long has he/she lived at this address? __________

14)               Any other name he/she has gone by? __________

15)               Any other address he/she has gone by? __________

16)               Do you share any joint credit card, mortgage, bank account etc with this person?

17)               Is there any other active financial link that you share with this person?

18)               Please specify why do you no longer want to be financially linked so that we can make a correct assessment of the situation? _________

19)               I confirm that there is no financial connection between me and the person mentioned above. _______________