Official Form 410 Proof of Claim

Official Form 410 Proof of Claim

What Is a Bankruptcy Proof of Claim?

Official Form 410, Proof of Claim , is a legal document completed by creditors in bankruptcy cases who need to stake their claims by submitting them to the bankruptcy court in a timely manner. This form allows you to be considered for payment - you will not be paid unless you specifically file a Proof of Claim approved by the bankruptcy court.

Alternate Names:

  • Bankruptcy Form 410;
  • Bankruptcy Proof of Claim.

This form was released by the U.S. Bankruptcy Court on April 1, 2022 , with all previous editions obsolete. Download a fillable Bankruptcy Proof of Claim Form through the link below.


Bankruptcy Form 410 Instructions

Follow these steps to fill out Bankruptcy Form 410:

  1. Identify the bankruptcy case - name the debtors, specify the court, and indicate the case number.
  2. Identify the claim. Name the current creditor - the individual or entity to be paid for this claim. State whether the claim was acquired from someone else and write down the addresses of the creditor.
  3. If the claim amends one already filed or you know someone else who has filed a proof of claim for this particular claim, answer "yes".
  4. Enter the number you use to identify the debtor and include the amount of the claim.
  5. Describe the basis of the claim and state whether all or part of the claim is secured by a lien on the property.
  6. If the claim based on a lease or subject to a right of setoff, answer "yes".
  7. If your claim is entitled to priority, check the appropriate box - domestic support obligations, penalties or taxes owed to the government, etc.
  8. Indicate your status - a creditor, creditor's authorized representative, trustee, debtor, guarantor, or another codebtor.
  9. Confirm the information in the form is true and correct, sign, and date the form. Record your contact information, and if you represent an entity, indicate the company and your title.

How to File a Proof of Claim in Bankruptcy Court?

Once the form is completed, attach copies of documentation that supports your claim: purchase orders, invoices, promissory notes, and security agreements. If your claim depends on a security interest in the debtor's residence, you need to file the following documents with Form 410:

When filing a Bankruptcy Proof of Claim, do not attach original documents and redact documents that identify the debtor or disclose health care information - you can only leave the last four digits of any social security number and the year of any individual's date of birth. Submit Official Form 410 to the clerk of the same bankruptcy court in which the bankruptcy case was filed.

Other Revision

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