Lawyers and Conveyancers Act (Lawyers: Fidelity Fund) Regulations 2008


r 12

Form 1
Claim against Lawyers' Fidelity Fund

r 12(1)(a)

To the New Zealand Law Society

Notice is given that [full name and address of claimant] has suffered pecuniary loss by reason of theft by [name of lawyer, incorporated law firm, or agent of lawyer or incorporated law firm] of $[amount of money or value of property stolen] entrusted to the practitioner, firm, or agent in the course of the provision of regulated services, or in that firm’s capacity as a solicitor-trustee, and accordingly claims against the Lawyers’ Fidelity Fund the sum of $[amount] as reimbursement in respect of the loss.

Particulars of claim

[Specify particulars of the matters giving rise to the claim, setting out fully the dealings with the person concerned leading up to the claim and attaching copies of any letters, accounts, statements, or other documents that are relevant.]

Particulars of amount of claim

[Specify particulars showing how the amount of the claim is calculated.]


Signature of claimant:

Signature of witness:

Name of witness:



Form 2
Declaration in support of claim against Lawyers' Fidelity Fund

r 12(2)

I, [full name, address, occupation], being a claimant against the Lawyers’ Fidelity Fund, solemnly and sincerely declare that the particulars set out in the notice of claim are full and true in all material respects.

And I make this declaration conscientiously believing the same to be true by virtue of the Oaths and Declarations Act 1957.

Declared at [place, date]

Before me: [name, signature]

(A person authorised to take a statutory declaration under the Oaths and Declarations Act 1957.)