How to submit an abuse form without your details going to the website owner?

Hi, Im trying to fill in the DMCA form available on the Cloudflare website (The Nameservers point to cloudflare so cant go directly to the hosting company)

How do I complete the form without sending my personal details to the website owner? The tick boxes are selected and disabled so I cant change - I dont want the offender to have my personal details!

How would the operator determine you are the rights holder without knowing who submitted the takedown request?

I dont mind the hosting company having the information. The form says that my personal information will go to the website owner too.

I dont want someone who is commiting fraudulent activities to have access to my name, email and phone number.

Under the DMCA the site operator has the right to verify that the content is, in fact infringing and that the person submitting the DMCA takedown request is the rights holder. They also have the opportunity to file a counter claim and/or sue for damages if they believe the request was fraudulent.

If you are unwilling to provide your own details, you should have an authorized agent (e.g. an attorney) submit the request and include their contact information.

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