SSA-1712-CN Cover Letter CN - Statement of Reclamation Action

Soclal Security Administration
To;
THE MANAGER
lnstitutlon#
Brancb Translt #

Re:

BEElEFlClARY INFORMATION
Beneflclary's Name
U.S. Social Security Number & BIC

-

U.S. W l Securlty Admlnlstrallon
OfAce of lntematlonal Operations
P.O. Box 1758
Baltimore, MD 21235-1756 U.S.A.

POTICE OF RECLAMATION-

PAYMENT INFORMATION
Payment Date Arnwnt Orsginal Amount paM Trace Number,
in CA$
Origlnal Payment
(US$)

Daposlior's Account N u m k With Yw

-

Company Entry Descrlptian
SOC SEC
Date of DeathMMIDDIW.
Institution #
Branch Transit #

This is to notify you of the death of a United States Soclal Security beneficiary whose benefits were paid
to your institution via electronic funds transfer. Payments made after the month of death are not due the
deceased. Please return the payment($) described bdw as a return item, via remittance with the
reference infomation to tha address Itsted below:.

Pawnent must be navable to The Bank of Nova S c d a and must be In the farm of bank draft
on the remittinn bank. monev order. or certified cheque. Payment made through other
instruments will be returned. In order to ensure that funds are applied to the correct deceased
beneficisrv's account, It is essential that you aude the US Social Security Numbr {SSN)and
send settlement to:
Bank:

The Bank of Nova Scotia, 95042
Shared Services, Mon Branch Centralbed Accounting Unit
888 Birchmount - 4'" Floor
Scarborough, Ontario, M1K 5L1

Bank Number:

0002

For Credit To:

BNS Cdn Gateway reclaims account - CA$

Account #: 950420001112
If funds are no longer available in the depositor's account, we would appredate any attempt you can make to contad the
e
m of the estate, or the nexl of kin, for a refund. For our recards, please complete the attached information sheet and
r a m to the address abwe. Should yoo have any questions regarding the retum of payment or if you are unable to comply
with this request please call the undersigned. Thank yw.