The Attorney Registration & Disciplinary Commission, an agency of the Illinois Supreme Court
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CLIENT PROTECTION PROGRAM


CLIENT PROTECTION PROGRAM CLAIM FORM

Instructions: Answer every question in this application. If space is inadequate, attach additional pages. It is important that you submit all evidence that proves your loss, such as canceled checks, receipts, letters, closing statements, etc.

Please Note: The ARDC does not accept claims by e-mail. 
Mail the completed application and other evidence to the attention of the ARDC Client Protection Program, 130 East Randolph Drive, Suite 1500, Chicago, Illinois 60601-6219.

PLEASE PRINT OR TYPE.

1. Your name: _____________________________________

Street address, Apt. #: _______________________________

City: ________________________ State: ____ Zip: _______

Home phone number: ______________________________

Cell phone number:  _______________________________

Business phone number: ____________________________

2. Name, address and telephone number of the attorney whose conduct caused your loss:
__________________________________________________

Street address: ______________________________________

City: _______________________ State: ____  Zip: _________

Phone number: ______________________________________

3. Date you hired the attorney: __________________________

Date attorney/client relationship ended: ____________________

4. What legal services did you ask this attorney to perform for you?
__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

5. How much money did you pay this attorney? ______________

State the amount of your loss: ___________________________

6. Was your agreement with this attorney in writing?  Yes___  No___
If yes, attach a copy of the agreement. 

7. Did any part of the loss consist of money given to the attorney in payment of fees?
Yes ____  No ____

If yes, state the amount: ___________________

8. Describe how and when your money or property came into the attorney’s possession:
___________________________________________________

___________________________________________________

___________________________________________________

___________________________________________________

9. State the date when the loss of your money or property occurred:
___________________________________________________

___________________________________________________

10. State the date when you discovered your loss, and how you discovered the loss:
___________________________________________________

11. Describe the attorney’s conduct and how it caused your loss:
___________________________________________________

___________________________________________________

___________________________________________________

___________________________________________________

12. Provide the names and addresses of any other persons who have knowledge of the loss:
___________________________________________________

___________________________________________________

___________________________________________________

13. This loss has been reported to: State’s Attorney ____ Police ____
ARDC ____ 

Furnish a copy of your complaint and describe what action was taken:
___________________________________________________

___________________________________________________

14. If you have not previously reported this loss, explain why:
___________________________________________________

___________________________________________________

___________________________________________________

___________________________________________________

15. Can your loss be reimbursed from any other source, such as insurance, fidelity bonds or surety agreements?

Yes ____ No ____ Don’t know ____  If yes, describe the source:

___________________________________________________

___________________________________________________

16. Describe what steps you have taken to recover the loss directly from the attorney, or any other source:
___________________________________________________

___________________________________________________

___________________________________________________

___________________________________________________

17. If the loss caused you special hardship, explain how:
___________________________________________________

___________________________________________________

___________________________________________________

___________________________________________________

18. State whether you have ever had a family or business relationship with the attorney and identify the relationship (e.g. spouse, child, parent grandparent, sibling, partner, associate or employee):
___________________________________________________

___________________________________________________

___________________________________________________

___________________________________________________

19. State other facts that you believe are important to the Program’s consideration of your claim:
___________________________________________________

___________________________________________________

___________________________________________________

___________________________________________________

20. Name of present attorney: ____________________________

Street address: _______________________________________

City: ___________________________ State: ____ Zip: _______

Phone number: ________________________

Commission rules do not permit attorneys who help clients process claims with the Program to charge legal fees for that service.

When the Commission makes a decision on your claim, the facts relating to your loss become a public record

Date: ________________

Signature of Claimant(s): ________________________________

 


 

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