INSTRUCTIONS: PROOF OF CLAIM

A proof of claim is submitted by creditors in a bankruptcy case to establish their claim for payment. This is filled out in response to a notice that a bankruptcy case has been established by the creditor in question. The proof of claim form may be attached with this notice or obtained from the website of the United States Courts system.

Proof of Claim Step 1: Enter the name of the debtor and the case number which has been assigned to their bankruptcy proceedings.

Proof of Claim Step 2: Enter the name of the creditor, as well as the name, address and contact information for where all subsequent notices regarding the progress of the case should be sent.

Proof of Claim Step 3: Enter the address where payments should be sent if it is different from the address listed above.

Proof of Claim Step 4: Enter the amount of the debt owed.

Proof of Claim Step 5: Enter the nature of the debt incurred, such as failure to pay for goods purchased or credit card debt.

Proof of Claim Step 6: Enter the last four digits of the social security number or tax identification number of the debtor.

Proof of Claim Step 7: If the debtor incurred their debt under a different name, list it next to 3a. If your business has a uniform claim number (used to identify large businesses), list it next to 3b.

Proof of Claim Step 8: If the claim is secured in the form of a lien placed upon the debtor's property (meaning it can be sold to pay off the debt), list the nature of the property in question, such as an automobile or real estate.

Proof of Claim Step 9: If your claim is defined as having priority under bankruptcy code 11 U.S.C. § 507 (a), note so under section 5. These include domestic support payments, wages or payments earned in the 180 days prior to bankruptcy being filed for and government taxes.

Proof of Claim Step 10: Note any payments which have been made by the creditor in section 6.

Proof of Claim Step 11: Attach copies of all documents which substantiate your claim, such as invoices.

Proof of Claim Step 12: Sign and date the form. This must be submitted to the bankruptcy court overseeing this case.