PDF FILES: ATTESTATIONS AND EXHIBITS


The Fund is providing the PDF files below to assist you in filing your claim. These files can be downloaded and printed for your convenience. Except where noted, these are provided as fillable PDF files that allow you to type the information into the forms rather than completing them by hand. Once the information is entered, you can print, sign, and date the form and mail it to the Fund. You may also save a copy of the file on your computer.

Please remember that regardless of whether you are submitting your claim online or using a hard copy claim form, you must mail a complete, original Exhibit A - "Authorization for Release of Medical Records" with original signatures to the VCF. If you are filing your claim online, you are encouraged to upload all other Attestations, Certifications, Exhibits and supporting documents to your online claim and are not required to mail the documents to the VCF.


If you decide to use the fillable versions of the Attestations and Exhibits, please note the following:


If you are submitting your claim online:


If you need assistance completing your claim form, please visit www.vcf.gov or call our toll-free Helpline at 1-855-885-1555 (or 1-855-885-1558 for the hearing impaired). If you are calling from outside the United States, please call 1-202-353-0356.

Personal Injury Claimants

Deceased Individuals


*These forms are not available as fillable PDFs but can be downloaded, printed, and then completed.