Claim / Incident / Disciplinary InformationIs any attorney in the firm aware of a professional liability claim made in the past five years against them, the firm, any predecessor firm, or against any current or former attorney of the firm wile affiliated with the firm?YesNoIs any attorney in the firm aware of an actual or alleged act, omission, circumstance, or breach of duty that a reasonable attorney would recognize might reasonably be expected to result in a claim being made against the firm, any predecessor firm, or against any attorney currently or formery affiliated with the firm or any predecessor firm, regardless of whether any such claim would be meritorious?YesNoWithin the past five years, has any attorney been subject to any disciplinary inquiry, compliant or proceeding for any reason including non-payment of dues?YesNoHas any attorney ever been refused admission to practice, disbarred, suspended, formally reprimanded, or sanctioned in any other way?YesNoApplicant InformationName Title Email Address Phone NumberPreferred Contact MethodEmailPhoneText Δ
