[Name of the check issuer]

[Check Issuer Address]

A [place] , [ date]

Subject: Rejecting your payment by check # [check number]

[Mister/Madam] ,

You gave me a check for [issuer's bank] number [check number] dated [check date] an amount of [check amount] , for payment of [ reason for payment (example: rent...)] ..

My bank has advised me that the check has been rejected for failing to make provision for your account.

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

Failure to regularize within 30 days from [check date] either by provisioning the account or 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 to you by judicial officer, it will then allow to operate a seizure on your property and income.

Cordially,

[Sign here]