| Financial Institution | Claim Number: | 
                  
                     
                     | Street Address | Bank Account No.: | 
                  
                     
                     | City/State/Zip Code | 
               
            
          
         We are writing to ask for some information about  (1)  , who has direct deposit of  (2)  Social Security benefit payment with you. We are unable to locate  (3)  at the address we have in our records:
         
          (4) 
         If we are unable to obtain a current address for  (5)  , we will stop  (6)  checks.
         
          
         What We Need 
         Please provide the mailing address you have for  (7)  , (8)  , in the space below, and return this letter in the enclosed envelope.
         
          
         Customer's Current Mailing Address is: 
          
          .               
          
          .               
          
          .               
          
         Right To Financial Privacy 
         A financial institution can provide the Social Security Administration with address
            information for a title II beneficiary without the person's consent. This conforms
            with the Right to Financial Privacy Act (12 U.S.C 3414 k.1).
         
          
         If You Have Any Questions 
         If you have any questions, or do not have this information please let us know right
            away. Please include the Social Security claim number shown above in any letter you
            send us.
         
          
         Enclosure: 
         Return Envelope