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How do I fill this out?
Begin by gathering all relevant information about the lost, stolen, or destroyed securities. Carefully fill out each section of the form using ink or a typewriter. Ensure you provide full descriptions and attach any required documents.
How to fill out the CLAIM FOR LOST, STOLEN, OR DESTROYED UNITED STATES REGISTERED SECURITIES?
1
Gather all relevant information about the securities.
2
Fill out each section of the form using ink or a typewriter.
3
Provide full descriptions of the securities.
4
Attach any required documents.
5
Sign the form in the presence of a certifying officer.
Who needs the CLAIM FOR LOST, STOLEN, OR DESTROYED UNITED STATES REGISTERED SECURITIES?
1
Individuals who have lost securities.
2
Individuals whose securities have been stolen.
3
Individuals whose securities have been destroyed.
4
Legal representatives of the owners of lost/stolen/destroyed securities.
5
Parents or guardians of minors named on the securities.
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What are the instructions for submitting this form?
To submit this form, gather all required documents and ensure the form is completed accurately. You can submit it via mail to the Bureau of the Fiscal Service, using their official mailing address. Alternatively, you may fax the form to the number provided by the Bureau or use their online submission portal if available. Remember to get the form notarized by a certifying officer before submission. Reviewing the Department of the Treasury's website for any updates or additional instructions is advisable.
What are the important dates for this form in 2024 and 2025?
This form was revised in November 2023. Ensure to check any specific submission deadlines or updates before completing the form.
What is the purpose of this form?
The purpose of this form is to officially report and claim loss, theft, or destruction of United States registered securities. This form helps individuals reclaim their lost assets by providing detailed information about the missing securities. Properly completing this form ensures that your claim is processed efficiently by the Department of the Treasury.
Tell me about this form and its components and fields line-by-line.
- 1. Title of Security: Identify the security by providing the interest rate, title, call, and maturity dates.
- 2. Registration: Enter the exact inscription on each security.
- 3. Serial Number: Provide the serial number of each security.
- 4. Face Amount: Mention the face amount of each security.
- 5. Taxpayer Identifying Number: Enter your Social Security Number or Employer Identification Number.
- 6. Current Ownership: State if you are the current lawful owner of the securities.
- 7. Assignment/Endorsement Information: Provide details if the securities were assigned, endorsed, or transferred.
- 8. Loss Details: Indicate whether the securities were lost, stolen, or destroyed and provide relevant details.
- 9. Recovery Efforts: Describe any steps taken to recover the securities.
- 10. Legal Representation: Mention your legal capacity and court appointment details if applicable.
- 11. Minor Information: Provide details if a minor is named on the securities.
- 12. Petition Statement: Certified statement acknowledging the transfer of ownership to the United States and agreement to indemnify.
- 13. Signature: Sign the form in the presence of a certifying officer.
What happens if I fail to submit this form?
Failing to submit this form may result in the inability to recover your lost, stolen, or destroyed securities. Additionally, you may not receive any reimbursement or compensation for the loss.
- No Recovery of Securities: Your lost, stolen, or destroyed securities will not be recovered.
- No Reimbursement: You may not receive any reimbursement or compensation for the lost securities.
- Legal Consequences: Failure to report lost or stolen securities may have legal consequences.
How do I know when to use this form?
- 1. Lost Securities: Report securities that have been lost.
- 2. Stolen Securities: Report securities that have been stolen.
- 3. Destroyed Securities: Report securities that have been destroyed.
- 4. Legal Representative: File on behalf of the owner if you are a legal representative.
- 5. Minors Named on Securities: Report if the securities are in the name of a minor.
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Is it required to print the form after filling?
While you can print the form, electronic submissions may also be accepted depending on the requirements.
Do I need to attach additional documents with this form?
Yes, please attach any required documents such as police reports or pieces of destroyed securities.
Can I fill out the form if I am a legal representative?
Yes, legal representatives can fill out the form on behalf of the securities' owners.
Is there a cost associated with submitting this form?
There is no cost for submitting the form itself, but there may be fees related to notarization or document handling.
How long does it take to process the form?
Processing times can vary, so it is important to submit all required information accurately and promptly.
Can I track the status of my submission?
You can contact the Department of the Treasury for updates on the status of your form submission.
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