Follow the steps to effectively complete the form online.

1. Click ‘Get Form’ button to access the Affidavit and Indemnity Agreement and open it for editing.
2. In Part I, fill out your full name in the space provided, and indicate your residential address. Specify whether you are the purchaser or payee of the check, and select the appropriate reason for your stop payment request.
3. Provide details about the loss of the check. Indicate the date on which the check was lost, stolen, or destroyed, or state if you never received the check. Ensure that the information provided is accurate and complete.
4. Fill out personal identification details, including your Social Security number and contact information. Ensure all contact numbers are current.
5. Sign the affidavit at the bottom of Part I, affirming that the information is correct and that you understand the conditions for the stop payment request.
6. In Part II, provide the date/time of your stop payment request, branch number, CSR number, and pertinent information about the check, such as check number, amount, and date.
7. Detail how, when, and where the loss of the check occurred in the designated space.
8. For Part III, indicate whether a replacement check has been issued prior to or after the 90-day waiting period, and select the method of indemnification if applicable.
9. Complete any necessary collateral information if a bond is required. Ensure to attach required documents, if any.
10. In Part IV, if applicable, provide a signature to release the stop payment order, along with the date and time.
11. After completing all sections, review the form for accuracy, save your changes, and prepare to download, print, or share the completed form as needed.

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