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Temporary Liquidity Guarantee Program - Demand and Proof of Claim Form

For your convenience, if you have a claim you may provide a copy of this completed form to the Federal Deposit Insurance Corporation by e-mail at TLGPDebtClaims@fdic.gov and we will begin processing your claim.

Please Note: A completed and signed form, along with appropriate exhibits, must be mailed or hand-delivered to the FDIC at the address listed on the claim form in order for your claim to be processed.

If you have any questions, please direct them to the TLGPDebtClaims@fdic.gov mailbox and we will respond to you as soon as possible.

Demand and Proof of Claim Form – PDF (PDF Help)
Demand and Proof of Claim Form – MS Word (Word Help)

Last Updated 4/6/2009 TLGPDebtClaims@fdic.gov