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Litigation Guardian

You must submit this form if you are the Litigation Guardian for a child, or an adult with impaired mental capacity, who is a participant in a CRT claim. You can submit this form after applying or responding to a claim. We will follow up with you once we process your form.

"*" indicates required fields

Does this dispute include a claim for damages for personal injury?*

Litigation Guardian's Contact Information

Name*

Information about the Child or Adult

Full legal name of the child or adult*
They are:*
MM slash DD slash YYYY
My role or relationship to this child or adult is:*

Declaration

By submitting this form, I confirm that:*
MM slash DD slash YYYY
This field is for validation purposes and should be left unchanged.