Form HIGF-01 "Application for Reimbursement From the Home Improvement Guaranty Fund" - Connecticut

What Is Form HIGF-01?

This is a legal form that was released by the Connecticut State Department of Consumer Protection - a government authority operating within Connecticut. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on October 1, 2010;
  • The latest edition provided by the Connecticut State Department of Consumer Protection;
  • Easy to use and ready to print;
  • Available in Spanish;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form HIGF-01 by clicking the link below or browse more documents and templates provided by the Connecticut State Department of Consumer Protection.

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Download Form HIGF-01 "Application for Reimbursement From the Home Improvement Guaranty Fund" - Connecticut

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For Official Use Only
HIGF-01, Rev 10/2010
STATE OF CONNECTICUT
DEPARTMENT OF CONSUMER PROTECTION
T R A D E S P R A C T I C E S D I V I S I O N
Telephone: (860) 713-6100
APPLICATION FOR REIMBURSEMENT FROM THE
HOME IMPROVEMENT GUARANTY FUND
I
:
NSTRUCTIONS
Applications for reimbursement from the guaranty fund must be submitted a minimum of thirty (30) days after the
court judgment, but must be received within 2 years from the date of the judgment and must be accompanied by all
required supporting documentation. The maximum amount paid to each consumer is $15,000 per contract.
You must provide the following documentation to substantiate your claim:
1. Copy of your home improvement contract(s);
2. Copy of the court judgment;
3. Copy of Writ of execution (BOTH Bank and Personal Property ) including statement from officer executing
same, if applicable (not applicable to Small Claims Judgments) and;
4. If bankruptcy discharge, a certified copy of the Discharge of Debtor Notice including the schedule in which
you are listed as a creditor; a copy of your contract and a copy of your check to the contractor or other proof
of payment to the contractor.
 Return your completed application to:
Department of Consumer Protection, Trade Practices Division, (HIGF FUND)
450 Columbus Boulevard. Suite 901. Hartford, CT 06103
CONSUMER INFORMATION:
Name
Address (No. & Street, City, State, Zip Code)
Contact Phone Number
Email Address
CONTRACTOR INFORMATION:
Name
Registration Number (if known)
Business Name
Work Telephone Number
with Area code
(
)
Address (No. & Street, City, State, Zip Code)
Date Contract was signed:
/
/
(Attach copy of contract)
Was the contractor registered at the time of your written contract or within two years prior to the date you signed the
contract or at the time of judgment?
YES
NO
(If you check “NO”, you cannot apply to the fund)
Are you the owner/resident of the private residence located in Connecticut where the home improvement work was to
be performed?
YES
NO
(If you check “NO”, you cannot apply to the fund)
Was the improvement for:
Single Dwelling
Multi Family Dwelling # of Units _____
Condominium
NOTE: NEW HOME CONSTRUCTION IS NOT ELIGIBLE FOR PAYMENT FROM THIS FUND.
For Official Use Only
HIGF-01, Rev 10/2010
STATE OF CONNECTICUT
DEPARTMENT OF CONSUMER PROTECTION
T R A D E S P R A C T I C E S D I V I S I O N
Telephone: (860) 713-6100
APPLICATION FOR REIMBURSEMENT FROM THE
HOME IMPROVEMENT GUARANTY FUND
I
:
NSTRUCTIONS
Applications for reimbursement from the guaranty fund must be submitted a minimum of thirty (30) days after the
court judgment, but must be received within 2 years from the date of the judgment and must be accompanied by all
required supporting documentation. The maximum amount paid to each consumer is $15,000 per contract.
You must provide the following documentation to substantiate your claim:
1. Copy of your home improvement contract(s);
2. Copy of the court judgment;
3. Copy of Writ of execution (BOTH Bank and Personal Property ) including statement from officer executing
same, if applicable (not applicable to Small Claims Judgments) and;
4. If bankruptcy discharge, a certified copy of the Discharge of Debtor Notice including the schedule in which
you are listed as a creditor; a copy of your contract and a copy of your check to the contractor or other proof
of payment to the contractor.
 Return your completed application to:
Department of Consumer Protection, Trade Practices Division, (HIGF FUND)
450 Columbus Boulevard. Suite 901. Hartford, CT 06103
CONSUMER INFORMATION:
Name
Address (No. & Street, City, State, Zip Code)
Contact Phone Number
Email Address
CONTRACTOR INFORMATION:
Name
Registration Number (if known)
Business Name
Work Telephone Number
with Area code
(
)
Address (No. & Street, City, State, Zip Code)
Date Contract was signed:
/
/
(Attach copy of contract)
Was the contractor registered at the time of your written contract or within two years prior to the date you signed the
contract or at the time of judgment?
YES
NO
(If you check “NO”, you cannot apply to the fund)
Are you the owner/resident of the private residence located in Connecticut where the home improvement work was to
be performed?
YES
NO
(If you check “NO”, you cannot apply to the fund)
Was the improvement for:
Single Dwelling
Multi Family Dwelling # of Units _____
Condominium
NOTE: NEW HOME CONSTRUCTION IS NOT ELIGIBLE FOR PAYMENT FROM THIS FUND.
Description of home improvement performed/contracted by contractor: _________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
Have you obtained a court Judgment / or Administrative Order:
YES
NO
If you check “NO”,
you cannot apply to the fund.
Was your judgment / or Administrative Order obtained against a contractor for loss or damages sustained by reason of
performance or the offering to perform home improvement in the State of Connecticut?
YES
NO
Amount Awarded on Judgment /Order:
$
/
/
Date of Court Judgment / Order:
Amount Paid on Judgment / Order:
$
(This application MUST be received within two (2) years
(If no Payment is received enter “0”)
from this date in order to be eligible to apply)
Balance Owed on Judgment / Order:
$
To your knowledge is the judgment or order being appealed by the contractor?
YES
NO
(If you check “YES”,
you cannot apply to the fund)
I have directed a sheriff to execute on my judgment against the contractor. The sheriff has
provided me with a return showing no personal property could be found to satisfy the
judgment or that the amount found was insufficient to satisfy my judgment. See attached
documentation. (Not necessary for Small Claims Judgments).
B A N K R U P T C Y
IF THE CONTRACTOR HAS FILED BANKRUPTCY, YOU MAY APPLY TO THIS FUND BY PROVIDING
THE FOLLOWING DOCUMENTATION:
1.
This application
2.
A Certified Copy of the Discharge of Debtor’s Notice
3.
Bankruptcy Schedule in which you are listed as a creditor
4.
Proof of Payment to Contractor
5.
Copy of your Contract with Contractor
Please be advised you will ONLY be reimbursed the amount indicated on the Bankruptcy Schedule.
C E R T I F I C A T I O N
I, _______________________________________________________, being duly sworn, depose and say that:
(HOMEOWNER)
1. I believe in the obligation of an oath.
2. I am at least eighteen (18) years of age.
3. This affidavit is based upon my personal knowledge.
I hereby certify that the foregoing statements are true and accurate to the best of my knowledge. In the event that I
also receive moneys from any other source, such as from bankruptcy court or from the contractor, for this claim. I
agree to repay the guaranty fund for any amount previously paid to me from the fund for this claim. In other words, I
hereby assign all my rights, title and interest in any amount which I may recover from the guaranty fund to the
Commissioner of Consumer Protection.
NOTARIZED STATEMENT
On ___________________________, 201___, before me personally appeared ______________________ of
_____________________, Connecticut, known to me and made oath to the truth of the matters contained herein.
Signed (Applicant) _____________________________
Subscribed and sworn to before me this _______ day of ________________________, 201______
Signed: __________________________________________
Commission Expires: _____________
(Comm. of Superior Court/Notary Public)
Failure to Fully complete this form may result in the denial or delay of your application
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