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121 Benefits 730 2nd Ave. S., Ste. 400 730 Building Minneapolis, MN 554022446 Phone: 800.300.1672 Fax: 877.918.3622 www.121benefits.com Lost Check Affidavit Form Employee Name: Employee ID Number:
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How to fill out lost check affidavit form
How to fill out lost check affidavit form
01
Read the instructions on the Lost Check Affidavit form carefully.
02
Fill in your personal information, such as your name, address, and phone number.
03
Provide details about the lost check, such as the check number, date, and amount.
04
Explain how the check was lost or stolen and provide any additional relevant information.
05
Sign and date the form.
06
Submit the completed Lost Check Affidavit form to the appropriate recipient or authority, as instructed.
Who needs lost check affidavit form?
01
Individuals who have lost or had a check stolen and wish to report it.
02
Bank customers who need to follow the process for potential reimbursement or investigation.
03
Anyone who wants to provide a legal documentation about the lost or stolen check.
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