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Hello:
This questionnaire is designed to identify areas of your activities that may be at-risk for the occurrence of unclaimed property. An accurate and complete response will assist in assessing whether a potential unclaimed property liability exists and avoid further enforcement action. Please answer all questions on both pages of this form that are relevant to your operation within 30 days. If a question does not apply, please respond by noting 'N/A' (not applicable). The scope of this self audit review should include records for the last ten years (i.e., 2002 through 2011).


Thank you very much for your time and support. Please start with the survey now by clicking on the Continue button below.

 
 
 
Please Enter Company Name:
   
 
 
 
Federal Employer ID #:
   
 
 
 
State of Incorporation/Organization
   
 
 
 
Year of Incorporation/Organization
   
 
 
 
Approximate Number of empoloyees?
   
 
 
 
Email Address
   
 
 
 
Is there a formalized policy in place to address Unclaimed Property?
 
Yes
 
No
 
N/A
 
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