Request a Certificate of Non-Payment (Document Template)

The request must be addressed to the bank of the check issuer.

Enter your first and last name, address and account number.

Instead, the date

Subject: Application for a certificate of non-payment

Dear Sir/Madam,

Check No. number of the NSF check in the amount of EUR [check amount] made payable to me by the name and first name of the issuer of the bank check of the issuer has been rejected for more than 30 days for insufficient provision.

Please send me a certificate of non-payment for possible seizure.


Verified 12 October 2021 - Directorate for Legal and Administrative Information (Prime Minister)

For details, please use the practical information sheets :

J'ai réalisé une démarche administrative

Je donne mon avis sur Services Publics +. L'administration concernée me répondra.