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Please carefully read the following instructions included with this claim form and complete ALL applicable questions to the best of your ability. If a question is inapplicable, please state “N/A.” All claim forms must be received no later than ______________.

The proof of claim form must be received by Slater Slater Schulman LLP by either:

  1. Completing this fillable form and emailing it to us at bsa@sssfirm.com; or
  2. Electronically by visiting www.__________.com; or
  3. If you are completing this form in hard copy, please type or print clearly using blue or black ink and hand deliver, U.S. Mail or courier the original claim form to:
    Slater Slater Schulman, LLP, 445
    Broad Hollow Road, Suite 419,
    Melville, New York 11747
    so that it is received before the deadline; or

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