Fillable claim of damage due to underencoding adjustment form

Description
CLAIM OF DAMAGE DUE TO UNDERENCODING ADJUSTMENT* To: Check Adjustment Department Federal Reserve Bank of Office We received a charge for an underencoding error for the forward collection check / qualified return check described below: 1. 2. 3. 4. 5. 6. 7. 8. Amount Charged Actual Amount Encoded Amount Dated Drawn By (Drawer) Payable To (Payee) Check No. Date of Underencoding Adjustment $ $
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claim of damage due to underencoding adjustment
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