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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: 

   

*City: 

   

*State: 

 

*Zip: 

-      

Daytime Phone: 

 

Evening Phone: 

 

Email Address: 

 

Account Number: 

*Taxpayer Identification No: 

   

If you are exempt from backup withholding


Disclaimer

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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