FS Form 1048 CLAIM FOR LOST, STOLEN, OR DESTROYED UNITED STATES SAVIN

Claim For Lost, Stolen or Destroyed U.S. Savings Bonds and Supplemental Statement For U.S. Securities

sav1048

Claim For Lost, Stolen or Destroyed U.S. Savings Bonds and Supplemental Statement For U.S. Securities

OMB: 1530-0021

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1530-0021 can be found here:

2021-12-29 - Extension without change of a currently approved collection

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For official use only: Customer Name _________________________________________________________Case No. ____________
FS Form 1048 (Revised August 2018)

OMB No. 1530-0021

Claim for Lost, Stolen, or Destroyed
United States Savings Bonds
IMPORTANT: Follow instructions in filling out this form. Making any false, fictitious, or fraudulent claim or statement to the United States is a crime.
Print in ink or type all information.

1. DESCRIPTION OF BONDS
Describe the missing bonds in the spaces below. If you don’t know the bond serial numbers, provide all of the information
requested below and also indicate the total number of bonds that are missing.
ISSUE DATE
(Specific month
and year of
purchase)

FACE
AMOUNT

BOND NUMBER

INSCRIPTION
(Provide complete Social Security Number [for example, 123-45-6789], names, including
middle names or initials, and addresses [street, city, state] on the bonds.
If a bond was received as a gift, provide the purchaser's Social Security Number.)

(If you need more space, attach either FS Form 3500 (see www.treasurydirect.gov/forms/sav3500.pdf), a plain sheet of paper,
or a photocopy of this section of the form.)

2. DETAILS OF THE LOSS – Mark the appropriate boxes and provide complete details of the loss.
The bonds were:
Stolen ⇒ Date of Theft: __________________

Lost

Was a police report filed?

Yes

Destroyed ⇒ Send any remaining pieces with this form.

No If Yes, attach copy of the report.

When was the loss discovered?

_____________________________________________________________________

Who had the bonds last and why?

_____________________________________________________________________

Who had access to the bonds?

_____________________________________________________________________

What was the result of your inquiry
to the person(s) who had access? _____________________________________________________________________
Where were the bonds last placed? _____________________________________________________________________
When were the bonds last seen?

_____________________________________________________________________

Were any identification documents also lost or stolen?

Yes

If Yes, please list them: ________________________________________________________________________
Have you received reimbursement because of the loss?

Yes

If Yes, please explain including details of any court proceedings pending or contemplated ____________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
FS Form 1048

Department of the Treasury | Bureau of the Fiscal Service

3. AUTHORITY – Provide details regarding your authority to complete a claim for the missing bonds.
Are you named on the bonds?

Yes

If Yes, skip to Item 4. If No, provide the following information:

Describe your authority: _______________________________________________________________________________
(Show authority: i.e., parent, guardian, conservator, legal representative, administrator, executor, etc.)

Are you court appointed?

Yes

(If Yes, see “LEGAL REPRESENTATIVE” in the instructions.)

4. MINORS – Provide details regarding any minor named on the bonds. (See "MINORS" in the instructions.)
Is there a minor named on the bonds?

Yes

If No, skip to Item 5. If Yes, fully complete the following:

What is the minor’s:
Name: ______________________________________________________ DOB? _________________________
Social Security Number? _________________________________________
What is your relationship to the minor? ___________________________________________________________________
Does the minor live with you?

Yes

If No, with whom? _____________________________________________________________________________
(Name)

(Relationship to Minor)

_____________________________________________________________________________
(Address)

Who provides the minor’s chief support?
_____________________________________________________________________________
(Name)

(Relationship to Minor)

_____________________________________________________________________________
(Address)

Are both parents able to sign the application for relief?

Yes

If Yes, skip to Item 5. If No, fully complete the following:
Why are you unable to obtain the signature? ________________________________________________________
Did that parent have access to the bonds?

Yes

Could that parent have possession of the bonds?

Yes

5. RELIEF REQUESTED – Indicate whether you want substitute bonds or payment. NOTE: Substitute bonds can’t be
issued in some cases, including if a bond is within one full calendar month of its final maturity.
A. Series EE or Series I Bonds
I/We hereby request:

Payment by Direct Deposit

B. Series HH Bonds
I/We hereby request:

Substitute Paper Bonds

Payment by Direct Deposit

6. DELIVERY INSTRUCTIONS
A. For Substitute Paper Bonds—Series HH
Mail Bonds To:
____________________________________________________________________________________________
(Name)

____________________________________________________________________________________________
(Number and Street, Rural Route, or P O Box)

FS Form 1048

(City)

Department of the Treasury | Bureau of the Fiscal Service

(State)

(ZIP Code)

B. For Direct Deposit Payment--Any Series of Bonds
Payee must provide a Social Security Number or Employer Identification Number:
______________________________________

__________________________________________

(Social Security Number of Payee)

(Employer Identification Number of Payee)

________________________________________________________________________________________
(Name/Names on the Account)

_________________________________________

Checking

Type of Account

Savings

(Depositor’s Account No.)

Bank Routing No. (nine digits): _______________________________
___________________________________________________
(Financial Institution’s Name)

______________________________
(Financial Institution’s Phone No.)

7. Signatures and Certification
I/We severally petition the Secretary of the Treasury for relief as authorized by law and, if relief is granted, acknowledge that the original
securities will become the property of the United States. Upon the granting of relief, I/we assign all our right, title, and interest in the
original securities to the United States and hereby bind myself/ourselves, my/our heirs, executors, administrators, successors and
assigns, jointly and severally: (1) to surrender the original securities to the Department of the Treasury should they come into my/our
possession; (2) to hold the United States harmless on account of any claim by any other parties having, or claiming to have, interests in
these securities; and (3) upon demand by the Department of the Treasury, to indemnify unconditionally the United States and repay to the
Department of the Treasury all sums of money which the Department may pay due to the redemption of these original securities, including
any interest, administrative costs and penalties, and any other liability or losses incurred as a result of such redemption. I/We consent to
the release of any information in this form or regarding the bonds described to any party having an ownership or entitlement interest in
these bonds.
I/We certify, under penalty of perjury, and severally affirm and say that the bonds described on this form have been lost, stolen, or
destroyed, and that the information given is true to the best of my/our knowledge and belief.
Sign in ink in the presence of a certifying officer and provide the requested information.
Sign
Here:_________________________________________________________________________________________________
(Signature)

_____________________________________________________

______________________________________________

(Print Name)

(Social Security Number)

Home Address ________________________________________

______________________________________________

(Number and Street or Rural Route)

(Daytime Telephone Number)

_____________________________________________________
(City)

(State)

______________________________________________

(ZIP Code)

(Email Address)

Sign in ink in the presence of a certifying officer and provide the requested information.
Sign
Here:________________________________________________________________________________________________
(Signature)

_____________________________________________________

______________________________________________

(Print Name)

(Social Security Number)

Home Address ________________________________________

______________________________________________

(Number and Street or Rural Route)

(Daytime Telephone Number)

_____________________________________________________
(City)

FS Form 1048

(State)

______________________________________________

(ZIP Code)

Department of the Treasury | Bureau of the Fiscal Service

(Email Address)

_____________________________________________________

______________________________________________

(Print Name)

(Social Security Number)

Home Address ________________________________________

______________________________________________

(Number and Street or Rural Route)

_____________________________________________________
(City)

(State)

(Daytime Telephone Number)

______________________________________________

(ZIP Code)

(Email Address)

Instructions to Certifying Officer: 1. Name(s) of the person(s) who appeared and date of appearance MUST be completed.
2. If a Medallion stamp is used an original signature is required. 3. Person(s) must sign in your presence.
I CERTIFY that _________________________________________________________________________ , whose identiy(ies)
(Names of Persons Who Appeared)

is/are known or proven to me, personally appeared before me this ________________ day of ____________________
(Month/Year)

at ___________________________________________________ and signed this form.
(City, State)
________________________________________________________
(Signature and Title of Certifying Officer)
________________________________________________________
(Name of Financial Institution)
________________________________________________________
(Address)
________________________________________________________
(City, State, ZIP code)
________________________________________________________
(Telephone)

I CERTIFY that _________________________________________________________________________ , whose identiy(ies)
(Names of Persons Who Appeared)

is/are known or proven to me, personally appeared before me this ________________ day of ____________________
(Month/Year)

FS Form 1048

Department of the Treasury | Bureau of the Fiscal Service

I CERTIFY that _________________________________________________________________________ , whose identiy(ies)
(Names of Persons Who Appeared)

is/are known or proven to me, personally appeared before me this ________________ day of ____________________
(Month/Year)

INSTRUCTIONS
IF YOU LIVE IN A DECLARED DISASTER AREA: You need to complete only parts 1, 5, 6.B. and 7. Write the word “DISASTER”
on the top of the first page of the form and on the front of the envelope.
PURPOSE OF FORM – Use this form to apply for relief on account of the loss, theft, or destruction of United States Savings Bonds.
"Bonds," as used on this form, refers to Savings Bonds, Savings Notes, Retirement Plan Bonds, or Individual Retirement Bonds.
WHO MAY APPLY – This form must be completed and signed by all persons named on the bonds, or by an authorized representative.
ATTACHMENTS – If you need more space for any item, attach either a plain sheet of paper, a photocopy of the relevant section, or, for
Part 1, a “Continuation Sheet for Listing Securities” (FS Form 3500), available at http://www.treasurydirect.gov/forms/sav3500.pdf.
PROOF OF DEATH – If a registrant is deceased, you must submit with this form a certified copy of his or her official death certificate.
LEGAL REPRESENTATIVE – If you were appointed as legal representative because:
•
the owner is deceased (with no surviving coowner or beneficiary named on the bonds), or
•
the owner or coowner is a minor, or
•
the owner or coowner is incapacitated,
complete the form and submit a court certificate or certified copy of your letters of appointment, under court seal and dated within one year
of submission, showing the appointment is still in full force. If your name and official capacity are shown in the registration of the bonds,
evidence of your appointment is not necessary.
If no legal representative has been appointed for a deceased or incompetent owner, advise the Bureau of the Fiscal Service and additional
instructions will be provided.
MINORS – A minor (who does not have a court-appointed guardian) who is requesting payment or who is named on Series HH bonds
may complete and sign the form on his or her own behalf if, in the opinion of the certifying officer, he or she is of sufficient competency
and understanding to comprehend the nature of the transaction. If, in the opinion of the certifying officer, the minor is not of sufficient
competency and understanding the parents must sign on behalf of the minor. If the minor does not reside with either parent, the form
must be completed and signed by the individual who furnishes the minor’s chief support.
AMOUNT OF BONDS EXCEEDS $5,000 – If the amount of the bonds involved exceeds $5,000 and an investigation was made by a law
enforcement agency or an insurance, transportation, or similar business organization, provide a copy of the report.
COMPLETION OF FORM – Print clearly in ink or type all information requested.
ITEM 1. Describe the missing bonds by bond serial number. If you don't know the bond serial numbers, you must provide the specific
month and year of purchase, and the Social Security Number, name (including middle name or initial), and complete address (street, city,
state) that appear on the bonds. Also state the total number of missing bonds. If you need more space, attach either a “Continuation
Sheet for Listing Securities” (FS Form 3500), available at http://www.treasurydirect.gov/forms/sav3500.pdf, a plain sheet of paper, or a
photocopy of this section of the form.
ITEM 2. Mark the appropriate boxes and provide complete details of the loss, theft, or destruction.

FS Form 1048

Department of the Treasury | Bureau of the Fiscal Service

ITEM 3. Provide details regarding your authority to complete a claim for the missing bonds. If you have been court-appointed, see
"LEGAL REPRESENTATIVE" above.
ITEM 4. Complete this item if a minor is named on the bonds and he or she is not of sufficient competency and understanding to
complete the form on his or her own behalf. Provide the minor’s name, date of birth, Social Security Number, and all other requested
information. See "MINORS" above for more information.
ITEM 5. Indicate whether you want substitute bonds or payment by direct deposit. If substitute bonds are requested and a bond is within
less than one full calendar month of reaching its final maturity, or has reached final maturity, payment will be made instead.
ITEM 6. Complete either section A or B. Which section is appropriate for you depends on which series of bonds you have and whether
you want payment or substitute bonds.
CERTIFICATION – Each person whose signature is required must appear before and establish identification to the satisfaction of an
authorized certifying officer. The signatures to the form must be signed in the officer's presence. The certifying officer must affix the seal
or stamp which is used when certifying requests for payment. Authorized certifying officers are available at financial institutions, including
credit unions, in the United States. Certification by a notary isn’t acceptable. Examples of acceptable seals and stamps:

•
•

The financial institution’s official seal or stamp, including: Signature Guaranteed seal or stamp; Endorsement Guaranteed seal
or stamp; Corporate seal or stamp (a corporate resolution isn’t required); or Issuing or paying agent seal or stamp (including
name, location, and four-digit identification number or nine-digit routing number)
The seal or stamp of Treasury-recognized Signature Guarantee Programs or other Treasury-approved Medallion Programs

WHERE TO SEND – Send this form and any additional information to the appropriate address below. Legal evidence or documentation
you submit cannot be returned.

•
•

For HH or H savings bonds – Treasury Retail Securities Site, P.O. Box 2186, Minneapolis, MN 55480-2186
For E, EE, or I savings bonds – Treasury Retail Securities Site, P.O. Box 214, Minneapolis, MN 55480-0214

For Bond-Related Inquiries:

•

Email: [email protected]

•

Phone: 844-284-2676 (toll free)

•

Fax: 612-629-4285

NOTICE UNDER PRIVACY ACT AND PAPERWORK REDUCTION ACT
The collection of the information you are requested to provide on this form is authorized by 31 U.S.C. CH. 31 relating to the public debt of
the United States. The furnishing of a Social Security Number, if requested, is also required by Section 6109 of the Internal Revenue Code
(26 U.S.C. 6109).
The purpose of requesting the information is to enable the Bureau of the Fiscal Service and its agents to issue securities, process
transactions, make payments, identify owners and their accounts, and provide reports to the Internal Revenue Service. Furnishing the
information is voluntary; however, without the information, the Fiscal Service may be unable to process transactions.
Information concerning securities holdings and transactions is considered confidential under Treasury regulations (31 CFR, Part 323) and
the Privacy Act. This information may be disclosed to a law enforcement agency for investigation purposes; courts and counsel for litigation
purposes; others entitled to distribution or payment; agents and contractors to administer the public debt; agencies or entities for debt
collection or to obtain current addresses for payment; agencies through approved computer matches; Congressional offices in response to
an inquiry by the individual to whom the record pertains; as otherwise authorized by law or regulation.
We estimate it will take you about 20 minutes to complete this form. However, you are not required to provide information requested
unless a valid OMB control number is displayed on the form. Any comments or suggestions regarding this form should be sent to the
Bureau of the Fiscal Service, Forms Management Officer, Parkersburg, WV 26106-1328. DO NOT SEND completed form to this
address; send to the appropriate address shown in "WHERE TO SEND" in the Instructions.

FS Form 1048

Department of the Treasury | Bureau of the Fiscal Service

File Type	application/pdf
File Title	FS Form 1048
Subject	Claim for Lost, Stolen, or Destroyed United States Savings Bonds
Author	Brenda A. Stauffer
File Modified	2018-08-23
File Created	2018-04-17