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Claim Form
A) Please certify the following:
B.) Please upload the following documents:

1.) A certified copy of the adverse judgment.
2.) A detailed line-item listing of all litigation costs.
3.) Invoices evidencing these costs.
4.) Proofs of payment.

Multiple file selection is allowed.
I hereby represent that the information contained herein is true, accurate, and complete and that no material facts have been suppressed or misstated.

Notice: For coverage to be provided, a Notice of Claim via this must be effectuated by you within forty-five (45) days following the date an "Adverse Judgment".