A payment or delivery pursuant to section five hundred twelve shall be accompanied by a written report, affirmed as true and accurate under penalty of perjury, in such form as the state comptroller may prescribe, setting forth:
1. With reference to any amount specified in subdivision one of section five hundred eleven, (a) A description of the security,(b) The number of shares represented or the face amount of the security,(c) The date the dividend or interest was payable, and(d) Such other information as the state comptroller may require.2. With reference to any amount specified in subdivision two of section five hundred eleven, (a) The name and last known address, if any, of the customer entitled to such amount,(b) The date of the last entry, other than the credit of interest or dividends, in the account in which such amount is reflected, recorded or included, and(c) Such other information as the state comptroller may require.3. With reference to any security specified in subdivision three or four of section five hundred eleven, (a) A description of the abandoned security,(b) The number of shares represented or the face amount of the security,(c) The name and last known address, if any, of the person appearing to be entitled to such abandoned property, and(d) Such other information as the state comptroller may require.4. In case any broker or dealer determines the property which shall be deemed abandoned property pursuant to subdivisions one and three of section five hundred eleven by the method provided in subdivision six of that section, the payment of such abandoned property shall be accompanied by a written report, affirmed as true and accurate under penalty of perjury, in such form as the state comptroller may prescribe, which, among other things, shall set forth the computation of the average factor of such broker or dealer pursuant to subdivision six of section five hundred eleven. Each written report accompanying the payment of abandoned property determined pursuant to subdivision six of section five hundred eleven shall contain an undertaking by the broker or dealer making such payment to honor all claims to the extent herein provided whenever made against such broker or dealer by any person determined by him or proved to be entitled to receive from him a stock or cash dividend received in this state during the calendar year covered by such report as the holder of record of a security or an interest payment on a security received in this state during such year. Such undertaking shall obligate the broker or dealer to honor any such claim provided that the payment of abandoned property relating to the year in question determined pursuant to subdivision six of section five hundred eleven made by such broker or dealer to the state comptroller has been exhausted as a result of reimbursements by the state comptroller to the broker or dealer or to other persons claiming such abandoned property as provided in subdivision two of section five hundred fourteen. To the extent related to any stock dividend, any such claim shall not exceed the fair market value of such stock dividend on the thirty-first day of December of the year in which such stock dividend was deemed abandoned property.N.Y. Aband. Prop. Law § 513