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 
(Deceased) 
The Claim of Abandoned Property is made pursuant to Title 28, Chapter 29 Virgin Islands Code 
 
Name of Deceased:  
 
Last Address of Deceased:  
 
Claimant’s Names:  
 
Mailing Address of Claimant:   
 
Telephone Number: Home:  
Work: 
 
Other: 
 
 
 
 Name of Institution  
 
Account No.:  
Safe Deposit Box No.: 
 
 
Policy No.:  
Certificate No.: _________________________ 
 
Amount:  
 
Description of Contents:  
 
The following documents are attached in support of this claim: 
 Passbook 
 Bank Certificate of Ownership 
 Certificate of Deposit 
 Death Certificate 
 Safe Deposit Receipt 
 Marriage Certificate 
 Picture I.D. 
 Birth Certificate 
 Affidavit of Lost Instrument  Copy of Judicial determination, i.e., Probate Will, Order, Decree. 
 
DATE: 
CLAIMANT’S SIGNATURE:  
 
 
 
Relationship to Deceased: 
 
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 Banking and Insurance 
On behalf of the Abandoned Property Administrator 
 
______________________________ 
Signature