GOVERNMENT OF THE UNITED STATES VIRGIN ISLANDS 
OFFICE OF THE LIEUTENANT GOVERNOR 
DIVISION OF BANKING, INSURANCE AND FINANCIAL REGULATION 
5049 Kongens Gade, St. Thomas, VI 00802-6487 • Tel: 340-774-7166 • Fax: 340-774-9458 
1131 King Street, Suite 101, Christiansted, VI 00820 • Tel: 340-773-6459 • Fax: 340-719-3801 
                      `********* 
CLAIM OF ABANDONED PROPERTY 
The Claim of Abandoned Property is made pursuant to Title 28, Chapter 29 Virgin Islands Code 
 
Owner’s Name: 
 
 
Mailing Address:  
 
 
Claimant’s Name:
 
 
Telephone Number: Home: 
 
Work: 
 
Other: 
 
 
 Name of Institution: 
 
 
Account No.: 
 
Safe Deposit Box No.:  
 
Policy No.: 
Certificate No.: 
 
Amount: $ 
 
Contents Description: 
 
 
The following documents are attached in support of this claim: 
Passbook 
  
Affidavit of Lost 
Instrument 
 
Safe Deposit 
Receipt 
 
Other 
Certificate of Deposit 
 
Bank Certificate of 
Ownership 
 
Picture I.D. 
 
 
 
DATE:   
CLAIMANT’S SIGNATURE: 
 
 
                                     *******FOR OFFICE USE ONLY******* 
 
Listing No: 
 
Year:  
Page No.: 
 
 
The claim has been allowed 
The claim has been denied: 
In Whole/In Part 
 
 
Director of Division of Banking, Insurance and Financial Regulation 
         On behalf of the Abandoned Property Administrator 
 
______________________________________ 
Signature