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Rule 14-911. Procedures and form; responsibilities of claimants tocomplete form.

(a) The Committee shall prepare and approve a form of claim forreimbursement.

(b) The form shall include at least the following informationprovided by the claimant under penalty of perjury:

(b)(1) the claimant's name and address, home and businesstelephone, occupation and employer, and social security number for purposes ofsubrogation and tax reporting;

(b)(2) the name, address and telephone number of the lawyer orlicensed paralegal practitioner who has dishonestly taken the claimant's moneyor property;

(b)(3) the legal or other fiduciary services the lawyer orlicensed paralegal practitioner was to perform for the client;

(b)(4) how much was paid to the lawyer or licensed paralegalpractitioner;

(b)(5) the copy of any written agreement pertaining to the claim;

(b)(6) the form of the claimant's loss involved (e.g. money,securities or other property) and the attachment of any documents that evidencethe claimed loss such as cancelled checks, title instruments, deeds or stockcertificates;

(b)(7) the amount of loss and the date when the loss occurred;

(b)(8) the date when the claimant discovered the loss and how theclaimant discovered the loss;

(b)(9) the lawyer's or licensed paralegal practitioner?s dishonestconduct and the names and addresses of any persons who have knowledge of theloss;

(b)(10) identification of whom the loss has been reported to (e.g.county attorney, police, disciplinary agency, or other person or entity), and acopy of any complaint and description of any action that was taken;

(b)(11) the source, if any, from which the loss could bereimbursed, including any insurance, fidelity or surety agreement;

(b)(12) the description of any steps taken to recover the lossdirectly from the lawyer, licensed paralegal practitioner or any other source;

(b)(13) the circumstances under which the claimant has been, orwill be, reimbursed for any part of the claim (including the amount received orto be received, and the source), along with a statement that the claimantagrees to notify the Committee of any reimbursements the claimant receivesduring the pendency of the claim;

(b)(14) the existence of facts believed to be important to theCommittee's consideration of the claim;

(b)(15) the manner in which the claimantlearned about the Fund;

(b)(16) the name, address and telephone number of the claimant'spresent lawyer or licensed paralegal practitioner, if any;

(b)(17) the claimant's agreement to cooperate with the Committeein reference to the claim, as required by the Utah or Federal Rules of CivilProcedure, in reference to civil actions which may be brought in the name ofthe Bar, pursuant to a subrogation and assignment clause, which shall also becontained within the claim;

(b)(18) the name and address of any other state fund to which theclaimant has applied or intends to apply for reimbursement, together with acopy of the application; and

(b)(19) the statement that the claimant agrees to the publicationof appropriate information about the nature of the claim and the amount ofreimbursement, if reimbursement is made.

(c) The claimant shall have the responsibility to complete theclaim form and provide satisfactory evidence of a reimbursable loss.

(d) The claim shall be filed with the Committee by providing thesame to the Utah State Bar, Fund for Client Protection at the Law and JusticeCenter, 645 South 200 East, Salt Lake City, Utah 84111.

Effective May 1, 2019