Claimant* Client* Examiner* Examiner Email Address* Examiners Phone:*Claim Number:*Type of Assignment Requested:* Please attach the 5020 if a new case.Max. file size: 23 MB.PhoneThis field is for validation purposes and should be left unchanged. Δ Please fill out the following fields in their entirety and attach the 5020 form. A representative from our office will be in contact with you to obtain additional details regarding this assignment. Thank you.
