Form Up 8-11 - Report Of Unclaimed Property Life Insurance
ADVERTISEMENT
1Report of Unclaimed Property
Life Insurance Form UP 8-11
1. Holder Name
FEIN Number
2. Item No.
3. Property Description
4. Property Type Code
5. Date of Last Activity or Limiting age
6. Dormancy Charge
7. Amount Remitted to Treasury $
8. Insured Social Security Number
9. Annuitant or Insured Name last, first, middle initial
10. Owner Date of Birth
11. Title
12. Country, If not USA
13. Last Known Address
14. Zip Code
City, State
15. Complete additional Owner boxes (below) if there is more than one Owner for this property and for Beneficiary Information
Additional Owner Name Last, First, MI
Address (if not the same as above)
Additional Owner SSN
Beneficiary Owner Name Last, First, MI
Address (if not the same as above)
Beneficiary SSN
2. Item No.
3. Property Description
4. Property Type Code
5. Date of Last Activity or Limiting age
6. Dormancy Charge
7. Amount Remitted to Treasury $
8. Insured Social Security Number
9. Annuitant or Insured Name last, first, middle initial
10. Owner Date of Birth
11. Title
12. Country, If not USA
13. Last Known Address
14. Zip Code
City, State
15. Complete additional Owner boxes (below) if there is more than one Owner for this property and for Beneficiary Information
Additional Owner Name Last, First, MI
Address (if not the same as above)
Additional Owner SSN
Beneficiary Owner Name Last, First, MI
Address (if not the same as above)
Beneficiary SSN
2. Item No.
3. Property Description
4. Property Type Code
5. Date of Last Activity or Limiting age
6. Dormancy Charge
7. Amount Remitted to Treasury $
8. Insured Social Security Number
9. Annuitant or Insured Name last, first, middle initial
10. Owner Date of Birth
11. Title
12. Country, If not USA
13. Last Known Address
14. Zip Code
City, State
15. Complete additional Owner boxes (below) if there is more than one Owner for this property and for Beneficiary Information
Additional Owner Name Last, First, MI
Address (if not the same as above)
Additional Owner SSN
Beneficiary Owner Name Last, First, MI
Address (if not the same as above)
Beneficiary SSN
AGENCY USE ONLY
PAGE:
OF:
16. PAGE TOTAL $
FIMS#____________ Deposit Date ____________
Date Accounts Entered __________ By Whom _____
IF LAST PAGE, ENTER GRAND TOTAL REMITTED $
Revised 10/07
Attach to UP 8-7
19
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial