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Part I. Claimant Identification

Please Enter Your Information (All fields marked with an * are required)

Complete the following.


*Beneficial Owner: 


Joint Owner: 

Name of IRA Custodian, if applicable: 

*Entity Name: 


Name of Representative, if applicable: 


*Address 1: 


Address 2: 








Daytime Phone: 


Evening Phone: 


Email Address: 


Account Number: 

*Taxpayer Identification No: 


If you are exempt from backup withholding


This site is not operated by Barclays Bank Plc. This site is operated and administered by a claims administration firm that handles all aspects of settlement notification. Please direct any questions to the Claims Administrator, Rust Consulting, Inc.

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