United States Bankruptcy Court District of Massachusetts

File Claim
Case Number
Example: 14-00002
Name of Creditor
Filed by

Before filing a Proof of Claim or amending a previously filed claim, you must read and agree to comply with each of the requirements listed below:
  1. The claimant shall comply with the requirements of Fed. R. Bankr. P. 3001(c) and (d) regarding the attachment of documentation in electronic format sufficient to establish the validity and status of the claim.
  2. The electronic filing of a proof of claim with the Clerk of Court shall constitute the filing claimant's approved signature by law and the provisions of 18 U.S.C. §152 shall apply to such filing.
  3. The electronic filing of a proof of claim in accordance with the Clerk's procedures shall constitute entry of the proof of claim in the claims register maintained by the Clerk pursuant to Fed. R. Bankr. P. 5003.
  4. The filer acknowledges that any electronically filed documents filed through this program are subject to being read by the public and agrees to redact all of the Social Security or taxpayer-identification numbers, except the last four digits; dates of birth; names of minor children; and financial account numbers, in compliance with Fed. R. Bankr. P. 9037. This requirement applies to all documents, including attachments.
  5. Only registered users of the Court's ECF system may use /s/ name as their signature.

I understand that, if I file, I must comply with the above listed requirements and the penalty for filing fraudulent claim: Fine of up to $500,000 or imprisonment for up to 5 years, or both. 11 U.S.C. §§ 152 and 3571.

NOTE: This form should not be used to make a claim for an administrative expense arising after the commencement of the case. A "request" for payment of an administrative expense may be filed pursuant to 11 U.S.C. § 503.

Installed Version: mab