1. (a) Each claimant seeking compensation from the fund shall, if the underlying crime is a vehicular crime, complete and submit a “Vehicular Crimes Insurance Form,” revised 8/23/2019 and available from the unit.

2. (b) In addition, each claimant shall provide the following:

   1. (1) A copy of the entire policy;
   2. (2) An itemized list of bills including the amounts billed and the amounts paid by the insurance carrier;
3. (c) If an attorney has been retained, an indication of whether the claimant has informed the attorney that the claimant is seeking compensation under these rules;
4. (d) An indication of whether any restitution or payment of a civil suit judgment has been received, and if so, the total amounts received;

5. (e) If any of the responses indicate that money has been paid to or on behalf of the claimant, the claimant shall provide:

   1. (1) The name and mailing address of the person, company, agency or other entity that paid or will be paying any portion of any expense; and
   2. (2) A description of the expenses incurred, and the amounts covered by those providing payment pursuant to (1) above; and
6. (f) A dated declaration that the information provided by the claimant is true, accurate, and complete, as evidenced by the claimant’s signature.

Source. #4864, eff 7-13-90, EXPIRED: 7-13-96 New. #7117, eff 10-8-99, EXPIRED: 10-8-07 New. #9553, eff 9-25-09, EXPIRED: 9-25-17 New. #12938, eff 12-9-19