Read the Instructions before fillng out this form.
This portal allows you to: (i) download a copy of the blank Confidential Survivor Proof of Claim form (which includes the Confidential Survivor Supplement) and complete the form offline; or (ii) download only a copy of the Confidential Survivor Supplement and complete the Supplement offline, and then, once you have completed the form or Supplement, attach it below, sign, and submit the form.
Click below to attach the completed form:
Click below to attach supporting documentation (multiple PDF files allowed, see instructions) .
A person who files a fraudulent claim could be fined up to $500,000, imprisoned for up to 5 years, or both. 18 U.S.C. §§ 152, 157, and 3571.