(Forms and Instructions for Lost Instrument Bond Application – North America)
TRAVELERS GUARANTEE COMPANY OF CANADA is not associated or affiliated with the Transfer Agent in any way. In addition to Travelers Guarantee's requirements for documentation, the Transfer Agent may have their own requirements for filing of documentation. Please direct these inquiries to their offices.
In order that such a bond is approved, TRAVELERS GUARANTEE COMPANY OF CANADA would require the following:
1. APPLICATION FOR LOST INSTRUMENT BOND AFFIDAVIT OF LOST CERTIFICATE AND INDEMNIFICATION
- Signed by the registered shareholder(s) / principal (e.g. beneficial individual owner or their legal representative(s) with supporting documentation).
Signatures to be acknowledged by a Commissioner for Oaths or notarized by a Notary Public.
- If more signatures are required, click here to download Application for Lost Instrument Bond Affidavit of Lost Certificate and Indemnification – Schedule A
2. AFFIDAVIT OF LOSS (Form required by Transfer Agent only)
- Complete in triplicate, duly executed by the registered shareholder(s). (Signed by a Commissioner for Oaths or notarized by a Notary Public.)
Click here to download Affidavit of Loss
3. PERSONAL NET WORTH STATEMENT – THIS IS ONLY REQUIRED IF THE CURRENT VALUE OF THE SECURITY (IES) EXCEEDS $100,000 CANADIAN.
- This must be completed by the registered shareholder(s)/principal (e.g. beneficial individual owner or their legal representative(s)).
Click here to download Personal Net Worth Statement
4. BANK REFERENCE LETTER – THIS IS ONLY REQUIRED IF THE CURRENT VALUE OF THE SECURITY (IES) EXCEEDS $100,000 CANADIAN.
- This must be completed by the bank on the bank's letterhead, signed by an officer, or account manager at the bank.
Click here to download Bank Reference Letter (SAMPLE ONLY)
Click here to download Brokerage Reference Letter (SAMPLE ONLY)
TRAVELERS GUARANTEE COMPANY OF CANADA has a general rule when underwriting these types of bonds. The indemnitor/applicant must have at least double the value of the bond in personal liquid net worth. Please provide back-up and confirmation of this. Any type of financial statements, investment portfolios and/or bank records may be submitted as evidence to back the Personal Net Worth Statement. Please keep in mind the general rule.
5. COPY OF TRANSFER AGENTS’ LETTER
- Confirming that a ‘stop transfer/adverse claim' has been placed against reported certificate(s). This letter must be dated within 12 months of the reported date of loss.
- Note; If this application represents lost Canada Savings Bonds please provide copies of all correspondence from Bank of Canada on their procedures for replacing the reported lost Canada Savings Bonds. The original Bond of Indemnity (also known as Lost Instrument Bond) provided to you by the Bank of Canada must accompany this application. On approval of your application Travelers Guarantee will execute the Bond of Indemnity, which will be required to be filed with the Bank of Canada.
6. PRIVACY CONSENT FORM
- Canada's privacy laws requires Travelers Guarantee Company of Canada to obtain an individual's informed consent prior to or at the point that our office requests an individual(s) to provide it with any personal information. Enclosed is a copy of Travelers Guarantee's Privacy Policy and the Conset Form that is to be completed by each individual personal indemnitor in this application process.
Click here to download Travelers Guarantee's Consent Form. - FOR QUEBEC RESIDENTS ONLY, click here to download Consent Form
7. PREMIUM
- The program rate for a Lost Instrument Bond request is 3% of the current market value of the securities or a minimum flat charge of $250.00 Canadian whichever is greater. Payment should be calculated on the day the application is forwarded to Travelers Guarantee. Payment must be made by Certified Cheque / Bank Draft / Money Order payable to TRAVELERS GUARANTEE COMPANY OF CANADA in Canadian Funds (U.S. or foreign currency funds will not be accepted).
As an alternative method of payment Travelers Guarantee will accept VISA / MasterCard. Should VISA / MasterCard be the choice of payment print off and complete the Credit Card Authorization Form. Click here to download "Credit Card Authorization Form".
Note: Payment must accompany the application or the request will be declined and returned. Payment will only be accepted once approval is granted for the bond request. Rates are subject to change without notice.
Kindly enclose the premium with the completed paperwork and forward to:
Travelers Guarantee Company of Canada
ATTN: Magda Pacheco
20 Queen Street West, Suite 300
P.O. Box 6
Toronto, Ontario, M5H 3R3
Upon receipt of the stated, we will review and consider issuance of the lost instrument bond. Travelers Guarantee reserves the right to request additional information.
