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IM-11710. Uniform Reclamation Form

This rule is no longer applicable. NASD Rule 11000 Series has been superseded by FINRA Rule 11000 Series. Please consult the appropriate FINRA Rule.

Uniform Reclamation Form To Accompany Reclamations
Subject to Rules & Regulations of:
Stock Clearing Corp.
Annex Clearing Corp.
National Clearing Corp.
NASD - uniform Practice code
RECLAIMED TO

Rec No. Name of Receiver Date Securities
Below Received
RECLAIMED BY

Del. No. Name of Deliverer Date of Return
Quantity

Security Description (certifcate's can be applied to reverse side of copy #1 Amount
Wrong Security __________ Should Be

Wrong Money __________ Our Money

Carries Due Bill

Duplicates Delivery __________ You Delivered On

Needs Signature Guarantee

Wrong Settlement Date __________ Our S/D

Needs Tax Stamp

No Instructions

Release Power of Attorney

Needs Legal Opinion

Coupon Missing

Needs Better Account Date

Other - Explanation



_______________

Name of Person making Reclamation (Print )


_______________

Telephone Number


_______________

Extension

ATTACH COPIES 1 & 2 TO CERTIFICATE - COPIES 3 & 4 ARE RETAINED BY DELIVERER

FORM AS SHOWN IS NOT DRAWN TO SCALE