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Hsbcform 1

This document is a claim form from HSBC requiring the claimant to provide personal information and documentation to process a claim for unclaimed funds. The form includes sections for claimant details, property information, and a certification statement regarding the validity of the claim. It also notes that processing may take up to 120 days and warns against fraudulent claims.

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pedropacas714
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14 views2 pages

Hsbcform 1

This document is a claim form from HSBC requiring the claimant to provide personal information and documentation to process a claim for unclaimed funds. The form includes sections for claimant details, property information, and a certification statement regarding the validity of the claim. It also notes that processing may take up to 120 days and warns against fraudulent claims.

Uploaded by

pedropacas714
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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HSBC Claim No.

9101687

Failure to complete this Claim Form including the submission of required Personal ID and other documentation will result in your claim being
returned to you.

Claimant Information

Claimant Name Claimant Address Claimant City/State/Zip

Best Phone Number Email Address

Are you the Original Owner of the Funds? if no, what is your relationship to the owner? Reason for claiming funds in place of owner

Did you use a Paid Professional Finder? If so, Finders Name is? Claimant's Date of Birth

Yes No

Property / Holder Information

Property ID - 1791252

(C) Holder Reporting Funds (D) Last Transaction Date

(E) Date Funds Received (F) Type of Funds Reported

(G) Certificate, Policy or Check Number (H) Amount Reported

Additional Owner(s):

Please note: Once we have received your form, we will then submit it and have a bank statement sent to you.

The undersigned claimant certifies that he/she is the proper claimant in the foregoing claim, that he/she read the foregoing claim and knows the contents
thereof; that the same is true and correct to his/ her knowledge that the information and documentation are unaltered and not fraudulent; and that the
claim is valid, and unpaid. The claimant understands that presentation of a fraudulent claim may result in criminal proceedings. The claimant further
declares that upon payment of this claim, he / she will indemnify and hold harmless; by signing this claim form, you are hereby granting Asset Recovery
Services permission to submit this claim form on your behalf.

Claimant Signature___________________________________ Date: _____________


Print Name of Claimant_________________________________________________
Co - Claimant Signature_________________________________________________
Print Name of Co - Claimant______________________________________________.
It can take up to 120 days to process your claim

Office Use Only Claim ID: 9101687


Approval Date/Examiner Initial

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