Form Ap1 - Report Of Unclaimed Or Abandoned Property - 2008 Page 4
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4AP-1 CHECKLIST - CONCLUDED
# OWNERS / #PROP.
$ REPORTED
# SHARES
INSURANCE
IN01 Indiv. Policy Benefits or Claims
IN02 Group Policy Benefits or Claims
IN03 Proceeds Due Beneficiaries
IN04 Proceeds From Matured Policies,
Endowments or Annuities
IN05 Premium Refunds
IN06 Unidentified Remittances
IN07
Other Amounts Due Under Policy
IN08 Agent Credit Balances
IN99 Aggregate
TOTAL
SECURITIES
SC01 Dividends
SC02 Interest (Bond Coupons)
SC03 Principal Payments
SC04 Equity Payments
SC05 Profits
SC06 Funds to Purchase Shares
SC07 Funds for Stocks & Bonds
SC08 Shares of Stock
(Returned by P.O.)
SC09 Cash For Fractional Shares
SC10
Unexchanged Shares of Successor Corp
SC11 Other Certs. of Ownership
SC12 Underlying Shares
SC13
Funds for Liquadition/Redemption
of unsurrendered Stock or bonds
SC14 Debentures
SC15 US Government Securities
SC16 Mutual Fund Shares
SC17 Warrants (Rights)
SC18 Matured Bond Principal
SC19 Dividend Reinvestment Plans
SC20 Credit Balances
SC99 Aggregate
TOTAL
ALL OTHER PROPERTY NOT IDENTIFIED ABOVE
ZZZZ ALL OTHER PROPERTY
TOTAL
GRAND TOTAL *
* Please total all property categories and enter grand total on front of form AP-1 in the Report Recapitulation section.
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