Form Ipnr- Iib (E) - Initial Report On Unclaimed Amounts Form - 2003
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1Commonwealth of Puerto Rico
Office of the Commissioner of Financial Institutions
Unclaimed Property Division
PO Box 11855 San Juan Puerto Rico 00910-3855
INITIAL REPORT ON UNCLAIMED AMOUNTS
AS OF JUNE 30, 200
(Required from institutions subject to the dispositions of section 37(a) of Act No. 55 of 1933, the Banking Act.)
August 10
Filing deadline:
Name of Reporting Company
Taxpayer Identification No.
Holder No.
Contact person
email address:
Telephone :
(
)
-
ext.
Fax (
)
-
Business Address
Postal Address
(if different)
Please select and complete the applicable certification
NEGATIVE CERTIFICATION: As required by Section 37(a) of Act No. 55 of 1933, as
amended, I certify that this institution has no Unclaimed Amounts to report, as of June 30, 200 .
As required by Section 37(a) of Act No. 55 of 1933, as amended, I hereby CERTIFY that this
institution is the holder of $
in Unclaimed Amounts as of June 30, 200 *
Name of person filing report
Title
Date filed
/ /
(dd/mm/yyyy)
Signature _______________________________________
This report may be filed by mail
Corporate
or by fax to (787) 723-4225.
Stamp
* The original of the report, duly signed, is to be filed along with a hard copy of the
Addendum to the Initial Report
(Form IPNR IIBA (E)).
on Unclaimed Amounts as of June 30
IPNR- IIB (E), revised in October,
2003
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