Unclaimed Balance Information
PAYMENT AUTHORIZATION FORM - VALID ONLY FOR PERSONAL(INDIVIDUAL)
DEPOSIT ACCOUNT CLAIMS
Name: WILMOT MRS ESTHER MAY FUNERAL ACC 915 0184 4
Payee:
Address: 55 KING ST W, TORONTO ON
Savings Account : 0149185 Transferred to Bank of Canada: $969.51
Last Transaction Date: 1993/5/11 Transfer Date: 2003/12/31
Status: UNCLAIMED Outstanding balance: $969.51
Originating Bank: THE TORONTO-DOMINION BANK , 55 KING ST W , TORONTO , ON, M5K1A2
STEP 1 - To be completed by CLAIMANT:
 Name:
 Address:
Phone:

Claimant's Signature: ________________________________________ Date: _______________

STEP 2 - AUTHORIZATION to be completed by the financial institution:
THE TORONTO-DOMINION BANK
55 KING ST W
TORONTO , ON
M5K1A2
 
Please select one of the following two boxes and affix the appropriate stamp:
 
This authorizes the Bank of Canada to pay the claimant the balance of the account indicated above plus interest if applicable. In accordance with Section 438 of the Bank Act, this balance was transferred to the Bank of Canada.
The client's signature has been authenticated against the signature card or the client's profile.
Signature-guarantee Stamp
 
This claim cannot be guaranteed, for the following reason(s):


Please provide any documentation (e.g., signature card and/or client profile) to assist in adjudicating the claim.
Branch Stamp

Authorizing Officer's Name (printed): ___________________________________________________________

Authorizing Officer's Signature: ____________________________________________ Date: _______________

   STEP 3 - FORWARD authorized form to:

Unclaimed Balances Services
BANK OF CANADA
234 Laurier Avenue West
Ottawa, Ontario K1A 0G9