Your First name/Last name

Address

Postal code/ CITY

EDF Mediator

Address

Postal code/ City

Done in [your city], on [specify the date].

Subject: Withdrawal letter for a lost check

Madam, Sir,

I, the undersigned [your full name], beneficiary of check No. [indicate the check number] in the amount of [indicate the amount in words and currency], that is [indicate the amount in figures and currency], drawn on the account of [name of the bank] and issued on [date of issuance].

This check has never reached me.

If it were to be found, I undertake to return it to you and not to present it for deposit.

Please accept, Madam, Sir, the expression of my respectful greetings.

[Your signature]