Due Diligence Verification Form A
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DUE DILIGENCE VERIFICATION FORM A
This verification form should be completed by holders stating what, if any, due diligence has
been performed on non securities property, and returned with your unclaimed property holder
report.
For holders who are not holders of securities (transfer agents):
I, _________________________________________ (name), am authorized to make this verification
on behalf of _____________________________________ (holder name). The facts set forth below
are true and correct to the best of my knowledge, information and belief.
1.
Holder has conducted the following searches for the owners of the unclaimed property
listed in this holder report: (Attach additional pages if needed)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
2.
Holder has not conducted a search for the owners of the unclaimed property listed
in this holder report: (Please check if no searches have been conducted and list
reasons).
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
____________________________________________
Signature
____________________________________________
Printed Name
____________________________________________
Date
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Parent category: Business