Ana səhifə

Los angeles


Yüklə 13.64 Kb.
tarix25.06.2016
ölçüsü13.64 Kb.




UNIVERSITY OF CALIFORNIA, DAVIS




BERKELEY DAVIS IRVINE LOS ANGELES RIVERSIDE SAN DIEGO SAN FRANCISCO










SANTA BARBARA • SANTA CRUZ




ACCOUNTING AND FINANCIAL SERVICES

ONE SHIELDS AVENUE



DAVIS, CALIFORNIA 95616-8504

(916) 757-8501




DECLARATION OF LOST OR DESTROYED UNIVERSITY OF CALIFORNIA, DAVIS CHECK


Check No:

     







Amount:

     







Dated:

     




I,      , Social Security No.      declare that:


I have been informed that a check drawn by The Regents of The University of California against its account maintained with Wells Fargo Bank – Davis office was issued to:      , as payee.




  1. I am the legal owner or entitled to possession of said check and said check has been (destroyed) (lost) and the facts of such (destruction) (loss) insofar as known to me are as follows:      




  1. I further agree that for and in consideration of the re-issuance to me of a check in lieu of the check originally issued and subsequently lost or destroyed, I will indemnify and hold harmless The Regents of the University of California against loss, damage, expense or any other liability which may be suffered by said The regents, either directly or indirectly, by reason of the issuance of said duplicate check or by the original instrument still remaining outstanding.




  1. I agree that, if a new check is issued to me in lieu of Check No.      , which has been lost, and if said check hereafter is placed in my possession, I will not negotiate, deposit or cash said check, but forthwith will deliver the same for cancellation to the Accounting Office, University of California, Davis, California 95616.




  1. Based upon the foregoing declaration and subject to the foregoing conditions, I hereby request The Regents to issue a new check to me in lieu of Check No.      .



I declare under the penalty of perjury under the laws of the State of California that the foregoing is true and correct.




Date:

     




Place:

Davis, California




Signature of Declarant:










Mailing Address of Declarant:

     




Verilənlər bazası müəlliflik hüququ ilə müdafiə olunur ©atelim.com 2016
rəhbərliyinə müraciət