Din Torah APPLICATION

*Please fill in as much information as possible in the fields below

Claimant (Toveah)
Name
Addresss
City
State
Zip
Phone Number
Fax Number
Defendant (Nitvah)
Name
Addresss
City
State
Zip
Phone Number
Fax Number
Brief Descrtiption of case
Claim
Note: Multiple forms must be submitted for multiple defendants. Note: A $200 application fee must be submitted with this form. There will be an additional $150 filing fee for any settlement negotiated with the aid of the Bais Din or for issuance of Hasraas Siruv and/or Siruv. I have read and understand the "Din Torah Fact Sheet" and/or the sections entitled Bais Din Facts and frequently asked questions at www.queensvaad.org before initiating this Din Torah.