[Check issuer name]

[Check issuer address]

A [location] , on [date]

Subject: Rejection of payment by check no [check number]

[Mr./Mrs.] ,

You gave me a check for [issuer's bank] no. [check number] dated [check date] by an amount of [check amount] , for the payment of [reason for payment (example: rent...)] .

My bank told me that the check was rejected because your account was not properly booked.

I would therefore ask you to please fund your account in order to allow a new payment.

Failing to regularize within 30 days from [check date] either by provisioning the account, by blocking the provision or by payment by another means, your bank will give me a certificate of non-payment.

This certificate can be served on you by a commissioner of justice, it will then allow you to make a seizure on your property and income.

Sincerely,

[Sign here]