This form is for Safe Connections Act line separation requests for Xfinity Mobile, NOW Mobile, and Comcast Business Mobile accounts. Note: Line(s) separated from a Comcast Business Mobile account will be converted to residential mobile service.

The Safe Connections Act and the implementing rules established by the Federal Communications Commission (“FCC” or “Commission”) enable certain individuals to request that a line or lines be separated from a shared mobile services account if they can document that a person on the account (hereafter, “abuser”) has committed or allegedly committed a “covered act” against them or someone in their care (collectively referred to as “survivors”). For purposes of the form, all references to “you,” “your,” or “I” in requests for information or certifications relate to survivors unless otherwise specified.