Rule 17A-011. Procedures and responsibilities for claimants.

A. Reimbursement form. The commission shall prepare and approve a form for claiming reimbursement. B. Contents of form. The form shall include at least the following information provided by the claimant under penalty of perjury: (1) the name, address, home and business telephone numbers, occupation, employer and social security number of the claimant; (2) the name, address and telephone number of the lawyer alleged to have dishonestly taken the claimant's money or property and any family or business relationship of the claimant to the lawyer; (3) the legal or other fiduciary services the lawyer was to perform for the claimant; (4) the amount paid to the lawyer; (5) the form of the claimant's loss (e.g. money, securities or other property); (6) the amount of loss and the date when the loss occurred; (7) the date the claimant discovered the loss and how the claimant discovered the loss; (8) the lawyer's dishonest conduct and the names and addresses of any persons who have knowledge of the loss; (9) the name of the person, if any, to whom the loss has been reported (e.g. district attorney, police, disciplinary agency or other person or entity) and a copy of any complaint and description of any action that was taken; (10) the source, if any, from which the loss can be reimbursed including any insurance, fidelity or surety agreement; (11) the description of any steps taken to recover the loss directly from the lawyer or any other source; (12) the circumstances under which the claimant has been, or will be, reimbursed for any part of the claim (including the amount received, or to be received, and the source); along with a statement that the claimant agrees to notify the commission of any reimbursements the claimant receives during the pendency of the claim; (13) the existence of facts believed to be important to the fund's consideration of the claim; (14) the manner in which the claimant learned about the fund; (15) the name, address and telephone number of the claimant's present lawyer; (16) the claimant's agreement to cooperate with the commission in reference to the claim or as required by Rule 17A-015 NMRA, in reference to civil actions which may be brought in the name of the commission pursuant to a subrogation and assignment clause which shall also be contained within the claim; (17) the claimant's agreement to repay the fund if the claimant is subsequently reimbursed from another source; (18) the name and address of any other state fund to which the claimant has applied or intends to apply for reimbursement, together with a copy of the application; and (19) a statement that the claimant agrees to the publication of appropriate information about the nature of the claim and the amount of reimbursement if reimbursement is made. C. Attachments to form. The following documents shall be attached to the form for claiming reimbursement: (1) a copy of any written agreement pertaining to the claim; (2) copies of any checks, money orders, receipts or other proofs of payment. D. Claimant responsibilities. The claimant shall have the responsibility to complete the claim form and provide satisfactory evidence of a reimbursable loss. E. Filing of claim. The claim shall be filed with the commission in the manner and place designated in the commission's rules.