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 
(By Power of Attorney) 
 
The Claim of Abandoned Property is made pursuant to Title 28, Chapter 29 Virgin Islands Code 
 
Owner’s Name: 
 
 
Name of Claimant By Power of Attorney:  
 
Social Security No./EIN 
(of Claimant by Power of Attorney) 
 
 
Mailing Address   
 
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 
 Affidavit of Lost Instrument 
 Certificate of Deposit 
 Bank Certificate of Ownership 
 Safe Deposit Receipt 
 Copy of Power of Attorney 
 Picture I.D. 
 Other 
 
 
DATE: 
 
CLAIMANT’S SIGNATURE: 
(Authorized by Power of Attorney) 
 
 
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