CONFIDENTIAL
ODC File No. _________

OFFICE OF DISCIPLINARY COUNSEL

BOARD ON PROFESSIONAL RESPONSIBILITY OF THE
SUPREME COURT OF THE STATE OF DELAWARE

CONFIDENTIAL COMPLAINT FORM

(Read the following materials before completing this form: Some Things You Should Know and Instructions for Filing a Complaint Against a Delaware Lawyer.)

(1) Your name and address:

(2) Telephone number: Residence Work

(3) The name of the lawyer being complained about. (See NOTE below.)

NOTE: If you are complaining about more than one Delaware lawyer, please provide your factual statement as to each lawyer on a separate sheet.

(4) Write and send with this form a statement of what the lawyer did or did not do that you are complaining about. Please state the facts as you understand them. If you employed the lawyer, describe what you employed the lawyer to do . Please be as factually specific as possible, supplying dates where appropriate. Sign and date such statement. Send your factual statement(s) with this form by first-class mail (NOT by certified or registered mail) to the following address:

OFFICE OF DISCIPLINARY COUNSEL
820 N. French Street, 11th Floor
Wilmington, Delaware 19801-3545

(5) If you are complaining about a lawyer who is representing you or has represented you, this Office may need to obtain copies of confidential documents relating to your complaint, and may eventually need to call you as a witness at a disciplinary hearing. Your signature below constitutes your authorization for this Office to obtain access to such documents as necessary in order to evaluate or investigate your complaint, and your consent to being called as a witness, if necessary.

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Signature

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Date