Western Australian Consolidated Regulations

UNCLAIMED MONEY REGULATIONS 1991 - SCHEDULE 1

Forms

FORM 1

(Reg. 2(3))

UNCLAIMED MONEY ACT 1990

NOTIFICATION TO TREASURER OF UNCLAIMED MONEY
OR PRESCRIBED RETAINED MONEY HELD

Name of holder ......................................................................................................

Address ..................................................................................................................

If the particulars of the person to whom or the place to which enquiries about the money should be directed are different from the particulars given above, please specify particulars of the different person and/or place
.................................................................................................................................
.................................................................................................................................

Name and (Last Known) Address of Owner of the Money	Amount of Money Held	Date When Holder Came Into Possession of the Money	Manner in Which Holder Came Into Possession of the Money

I certify that the above information is correct.

...................................................................
(Signature of holder or his/her legal personal representative (where the latter, name and address to be shown))

FORM 2

(Reg. 3(2))

UNCLAIMED MONEY ACT 1990

NOTIFICATION TO TREASURER OF PAYMENT OF UNCLAIMED
MONEY OR PRESCRIBED RETAINED MONEY

1.         Name and address of person who made the payment .......................................
...........................................................................................................................

2.         Amount of money paid .....................................................................................

3.         Name of person to whom the payment was made ............................................
...........................................................................................................................

4.         Address at which the money was handed over or to which it was sent ............
...........................................................................................................................

5.         Date of the payment ..........................................................................................

I certify that the above information is correct.

...................................................................
(Signature of payer or his/her legal personal representative (where the latter, name and address to be shown))

FORM 3

(Reg. 5)

UNCLAIMED MONEY ACT 1990

PAYMENT TO TREASURY UNDER SECTION 13

1.         Name and address of person making the payment ...........................................
...........................................................................................................................

2.         Amount of payment ..........................................................................................

3.         Name and (last known) address of owner of the money ..................................
...........................................................................................................................

4.         Date when person making the payment came into possession of the money ...
......................................................................................................................................................................................................................................................

5.         Manner in which person making the payment came into possession of the money ...............................................................................................................
...........................................................................................................................

6.         If applicable, details of unfulfilled obligations in respect of the money being paid ...................................................................................................................
...........................................................................................................................

7.         If applicable, the amount of the balance of money to be paid to owner ...........
...........................................................................................................................

I certify that the above information is correct.

...................................................................
(Signature of payer or his/her legal personal representative (where the latter, name and address to be shown)).