Report/Application for Relief on Account of Loss, Theft, or Destruction of U.S. Bearer Securities (Individuals)

OMB 1530-0033

The information is requested to establish ownership and support a request for relief due to the loss, theft, or destruction of United States Bearer Securities owned by individuals.

The latest form for Report/Application for Relief on Account of Loss, Theft, or Destruction of U.S. Bearer Securities (Individuals) expires 2023-07-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form FS Form 1022-1 Report/Appl. for relief of loss, theft, destruction of U.S. Bearer Securities Form and Instruction
1530-0033 Supporting Statement 2019.docx Supporting Statement A
Report/Appl. for relief of loss, theft, destruction of U.S. Bearer Securities Form and Instruction

All Historical Document Collections

201904-1530-005 Approved without change	Reinstatement with change of a previously approved collection	2019-12-03
201511-1530-005 Approved without change	Extension without change of a currently approved collection	2015-11-30
201407-1530-035 Approved without change	Extension without change of a currently approved collection	2014-07-31