A Statement of Claim form needs to be completed, signed and dated. A claim form may be downloaded or you may contact the Fund to have a claim form mailed. Please read the Instructions prior to completing the Statement of Claim form.
- All questions on the Statement of Claim form must be fully answered, providing as much information regarding the basis of the claim as possible.
- The last page of the claim form provides that the statements and information set forth on the claim form are made subject to the penalties of 18 Pa.C.S. § 4904 (relating to unsworn falsification to authorities).
- Documentation to support the claim should be included. Such documentation may include:
- Copies of the front and back of all canceled checks evidencing payments made to the attorney or receipts for the payments;
- A copy of the fee agreement with the attorney;
- Copies of correspondence to and from the attorney discussing the money and/or property; and
- Any other documentation that would support the facts of the claim.
- The properly completed, signed Statement of Claim, together with the supporting documentation, should be mailed to the Executive Director at the address set forth on the claim form.
- Information and documentation being mailed via regular or certified mail should be sent to the post office box address on the form. The street address is provided for those who are sending information via overnight delivery or messenger.
- If a corresponding disciplinary complaint has not previously been filed with the Disciplinary Board, a completed Disciplinary Complaint Form must be included with the Statement of Claim.
- The filing of a Disciplinary Complaint form is not required if the attorney is deceased.