Information And Claim Form printable pdf download

Information And Claim Form

Government Claims Program Information and Claim Form

The State Bar of California

180 Howard Street

San Francisco, CA 94105

NFORMATION AND

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What kind of claims can be filed? Claims can be filed for losses you believe were caused by the action, or inaction, of

The State Bar of California. Claims may include:

•

Damage to real or personal property

•

Personal Injury

•

Contract Disputes

Who can file a claim?

Anyone who believes The State Bar of California caused him or her to suffer monetary loss can file a claim.

What are the time limits for filing a claim?

Claims relating to the death or injury of a person, or damage to personal property, must be filed no later than six months

after the date of the incident. Other claims must be filed no later than one year after the date of the incident. You may

want to consult an attorney if you are not sure how the time limits apply to your claim.

Instructions for filling out this form:

Provide the full name of the person claiming damage or injury.

Provide a daytime telephone number.

Provide an email address. (Optional)

Provide a complete mailing address. This is the location that notice of action on you claim will be sent.

Let us know the best way to contact you if we need to call you.

If the claim is being filed on behalf of a minor (someone under the age of 18), please give the minor’s date of

birth.

You may wish to consult an attorney for assistance with filing a claim, however it is not required. If an attorney or

other person (such as the parent or legal guardian of a minor or conservator of an adult) is representing you,

please complete this section. If this section is completed, all correspondence regarding this claim will be sent to

the representative.

Provide a daytime telephone number, including area code, for the attorney or representative.

Provide an email address for the attorney or representative. (Optional)

Provide a complete mailing address for the attorney or representative.

State Bar Claim Form (last revised November 2005)

Information And Claim Form