State Codes and Statutes

The form for a fund claim shall be executed under penalty of unsworn falsification and must include

(1) the name and address of each originator licensee involved;

(2) the amount of the alleged loss;

(3) the date or period of time during which the alleged loss occurred;

(4) the date when the alleged loss was discovered;

(5) the name and address of the claimant; and

(6) a general statement of the facts related to the fund claim.

The form for a fund claim shall be executed under penalty of unsworn falsification and must include

(1) the name and address of each originator licensee involved;

(2) the amount of the alleged loss;

(3) the date or period of time during which the alleged loss occurred;

(4) the date when the alleged loss was discovered;

(5) the name and address of the claimant; and

(6) a general statement of the facts related to the fund claim.

The form for a fund claim shall be executed under penalty of unsworn falsification and must include

(1) the name and address of each originator licensee involved;

(2) the amount of the alleged loss;

(3) the date or period of time during which the alleged loss occurred;

(4) the date when the alleged loss was discovered;

(5) the name and address of the claimant; and

(6) a general statement of the facts related to the fund claim.

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