Section Jus 604.03 - Vehicular Crimes Insurance Form(a) Each claimant seeking compensation from the fund shall, if the underlying crime is a vehicular crime, complete and submit a "Vehicular Crimes Insurance Form," revised 8/23/2019 and available from the unit. (b) In addition, each claimant shall provide the following: (1) A copy of the entire policy;(2) An itemized list of bills including the amounts billed and the amounts paid by the insurance carrier; (c) If an attorney has been retained, an indication of whether the claimant has informed the attorney that the claimant is seeking compensation under these rules; (d) An indication of whether any restitution or payment of a civil suit judgment has been received, and if so, the total amounts received; (e) If any of the responses indicate that money has been paid to or on behalf of the claimant, the claimant shall provide:(1) The name and mailing address of the person, company, agency or other entity that paid or will be paying any portion of any expense; and(2) A description of the expenses incurred, and the amounts covered by those providing payment pursuant to (1) above; and(f) A dated declaration that the information provided by the claimant is true, accurate, and complete, as evidenced by the claimant's signature.N.H. Admin. Code § Jus 604.03
#4864, eff 7-13-90, EXPIRED: 7-13-96
New. #7117, eff 10-8-99, EXPIRED: 10-8-07
New. #9553, eff 9-25-09
Amended by Volume XL Number 2, Filed January 9, 2020, Proposed by #12938, Effective 12/9/2019, Expires 12/9/2029.