Form Tfs-2006 Check Replacement Request And Indemnification Bond printable pdf download

CHECK REPLACEMENT REQUEST AND INDEMNIFICATION BOND

(Endorsed check)

Note to Electronic Return Originator (“ERO”): An endorsed check must not be replaced before the original

check is stale-dated (the earlier of 60 days from date of issue or June 15, 2008).

If the replacement check is to be printed by the

If the replacement check is to be printed by

tax office:

HSBC TFS Account Research:

* Do not fax ID bond to HSBC Taxpayer

* Fax completed ID bond to 1-800-709-0034.

Financial Services Inc. (HSBC TFS).

* Retain a copy of the ID bond for your files.

* Retain the completed ID bond in the ERO files.

---to be completed by ERO---

PRIMARY APPLICANT: _________________________________SSN: ________-________-_________

JOINT APPLICANT: ____________________________________SSN: ________-________-_________

CURRENT MAILING ADDRESS: _________________________________________________________

____________________________________________________________________________________

CHECK NUMBER: ___________________TELEPHONE NUMBER: _____________________________

REASON FOR REQUESTING CHECK REPLACEMENT: ______________________________________

FILING STATUS ON TAX RETURN:

Single

Married filing joint return

Married filing separate return

Head of Household

Qualifying widow

---To be completed by applicants---

In consideration of a new cashier’s check being issued by HSBC Bank USA, National Association

or HSBC Trust Company (Delaware), National Association (each referenced herein as “HSBC”), to replace

cashier’s check Number

_________________ in the amount of $ _____________ originally issued on ____________________

(date)

(the “Original Cashier’s Check”), the undersigned represent and agree that:

The Original Cashier’s Check was received and endorsed by the undersigned and has been either lost, destroyed, or

misappropriated. It has not been presented, sold, transferred or assigned by the undersigned. The undersigned agrees, at all

times hereafter, to save, defend, hold harmless and indemnify HSBC, HSBC TFS, and their successors and assigns from and

against any and all claims related in any way to the presentation, collection or attempted collection of the Original Cashier’s

Check and from all expenses related thereto, including, but not limited to, attorney’s fees to the extent allowed by law, resulting

from the negligent, reckless, or willful act or omission of the undersigned.

SIGNATURE:______________________DATE:__________WITNESS:_____________DATE:________

ERO Name:______________________________________ERO Phone #:________________________

(Please print)

Note: Both applicants must sign if the application was signed by both applicants. The ERO must witness at least

one of the signatures above.

TFS-2006 (01/2008)

Form Tfs-2006 Check Replacement Request And Indemnification Bond

Related Articles

Related forms

Related Categories