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Form Up-1k, Up-2k, Up-3k - Safe Deposit Boxes Report And Instructions - Unclaimed Property Program Page 2

INSTRUCTIONS FOR FORM UP-1K

SAFEKEEPING

The form UP-1K must accompany all holder reports.

HOLDER INFORMATION:

Please type or print your report!

ITEM 1- Enter your federal employer identification number.

ITEM 2- Enter your institution name and mailing address.

ITEM 3- If this report is being prepared by an agent on behalf of the institution, enter the agent’s name

and address.

ITEM 4- Enter the name of the person completing the form.

ITEM 5- Enter the telephone number for the person completing the form.

ITEM 6- Enter the electronic mail address for the person completing the form.

ITEM 7- Enter the date your institution was incorporated or registered.

ITEM 8- Enter the state where your institution is registered or incorporated.

REPORT INFORMATION:

ITEM 9 - Enter total number of safe deposit boxes.

VERIFICATION:

This report must be certified by a CFO, partner or company officer.

GO TO OWNER REPORT FORM (UP-2K) TO PROVIDE A DETAILED LISTING OF THE UNCLAIMED

ACCOUNTS REFLECTED IN ITEM 9.

Form Up-1k, Up-2k, Up-3k - Safe Deposit Boxes Report And Instructions - Unclaimed Property Program Page 2