Applications for Reimbursement

(a) The Board shall prepare a form of application for reimbursement; in its discretion the Board may waive the requirement that a claim be filed on such form. (b) The form shall be executed under penalty of perjury and shall require, as minimum information: (1) The name and address of the lawyer. (2) The amount of the alleged loss. ALASKA BAR RULES (3) The date or period of time during which the alleged loss was incurred. (4) The date upon which the alleged loss was discovered. (Added by SCO 214 effective January 1, 1976; amended by SCO 407 effective, nunc pro tunc, January 1, 1980; and by SCO 1217 effective July 15, 1995) (5) Name and address of the applicant. (6) The general statement of facts relative to the application. (7) A statement that the applicant has read these rules and agrees to be bound by them. (8) A statement that the loss was not covered by any insurance, indemnity or bond, or if so covered, the name and address of the insurance or bonding company, if known, and the extent of such coverage and the amount of payment, if any made. (c) The form or application shall contain the following statement in bold type: