Read the instructions before filling out this form.
This portal allows you to download a copy of the blank Proof of Claim form and complete the form offline. Once you have completed the form, please 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.