Claim Supp

This document is a claim supplement form providing details about an incident, claim, or lawsuit against an applicant firm. It requests information such as the name of the applicant firm and individuals involved, other defendants, potential claimants, date of the alleged act or omission, present status of the claim including payments and reserves, description of events leading to the claim, steps taken to prevent future losses, and a signature from an officer of the firm acknowledging the truth and completeness of the statements.