Rule 14-911. Procedures andform; responsibilities of claimants to complete form.
(a) The Committee shall prepareand approve a form of claim for reimbursement.
(b) The form shall include atleast the following information provided by the claimant under penalty ofperjury:
(b)(1) the claimant's name andaddress, home and business telephone, occupation and employer, and socialsecurity number for purposes of subrogation and tax reporting;
(b)(2) the name, address andtelephone number of the lawyer who has dishonestly taken the claimant's moneyor property;
(b)(3) the legal or otherfiduciary services the lawyer was to perform for the client;
(b)(4) how much was paid to thelawyer;
(b)(5) the copy of any writtenagreement pertaining to the claim;
(b)(6) the form of theclaimant's loss involved (e.g. money, securities or other property) and theattachment of any documents that evidence the claimed loss such as cancelledchecks, title instruments, deeds or stock certificates;
(b)(7) the amount of loss andthe date when the loss occurred;
(b)(8) the date when theclaimant discovered the loss and how the claimant discovered the loss;
(b)(9) the lawyer's dishonestconduct and the names and addresses of any persons who have knowledge of theloss;
(b)(10) identification of whomthe loss has been reported to (e.g. county attorney, police, disciplinaryagency, or other person or entity), and a copy of any complaint and descriptionof any action that was taken;
(b)(11) the source, if any,from which the loss could be reimbursed, including any insurance, fidelity orsurety agreement;
(b)(12) the description of anysteps taken to recover the loss directly from the lawyer or any other source;
(b)(13) the circumstances underwhich the claimant has been, or will be, reimbursed for any part of the claim(including the amount received or to be received, and the source), along with astatement that the claimant agrees to notify the Committee of anyreimbursements the claimant receives during the pendency of the claim;
(b)(14) the existence of factsbelieved to be important to the Committee's consideration of the claim;
(b)(15) the manner in which theclaimant learned about the Fund;
(b)(16) the name, address andtelephone number of the claimant's present lawyer, if any;
(b)(17) the claimant'sagreement to cooperate with the Committee in reference to the claim, asrequired by the Utah or Federal Rules of Civil Procedure, in reference to civilactions which may be brought in the name of the Bar, pursuant to a subrogationand assignment clause, which shall also be contained within the claim;
(b)(18) the name and address ofany other state fund to which the claimant has applied or intends to apply forreimbursement, together with a copy of the application; and
(b)(19) the statement that theclaimant agrees to the publication of appropriate information about the natureof the claim and the amount of reimbursement, if reimbursement is made.
(c) The claimant shall have theresponsibility to complete the claim form and provide satisfactory evidence ofa reimbursable loss.
(d) The claim shall be filedwith the Committee by providing the same to the Utah State Bar, Lawyers' Fundfor Client Protection at the Law and Justice Center, 645 South 200 East, SaltLake City, Utah 84111.