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Comments/Questions

Describe how you believe that the company has violated the False Claims Act. Please include the following information:

1. What actions or activities do you believe were fraudulent? Were these acts intentional?

2. Who was engaged in the fraud? What are their job titles or positions, and what role did those people play in the fraud?

3. When and how did you become aware of the fraud? How could you prove that these actions are occurring on a regular basis?

4. When did the fraud begin? Has it ended? If so, when?

5. Have you discussed your allegations with anyone, including your employer, a local, state or federal government official or someone in the media? If so, please state with whom you discussed the matter, the circumstances and any response. If you have not discussed these allegations with anyone, please do not do so until you complete and submit this case evaluation form.

6. If you lost your job, have you filed or are you considering filing a wrongful termination lawsuit? Please describe any action you have taken in this regard. Have you been retaliated against because you spoke out against the fraud(s) you see at work?

7. Have your allegations been the subject of any legal or legislative action? For example, have they been disclosed in the course of a wrongful termination action, a products liability case, a congressional hearing or agency proceeding? If so, please describe.

8. How much, in dollar terms, would you estimate the government has been damaged by the alleged wrongdoing? (In your calculations, exclude any penalties.) Describe how you arrived at your estimated damages. This estimate can include Federal and State government damages.

9. Please describe what you believe to be the financial capability of the company to pay a False Claims Act judgment. Are they a publicly owned company? Do they receive over one million dollars per year in Medicare or Medicaid dollars?

10. Have you ever filed a lawsuit against anyone or any company before?

If yes, what was the case about?

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The information which you give in completing this form will be forwarded to the designated party for its use and will not be used by YELLOWPAGES.COM from BellSouth ^TM for any other purpose or provided by us to any other parties. If you wish information concerning the privacy policy or the designated recipient, you should contact them directly.

Important notice

These pages should not be construed to contain legal advice. While we will treat any information provided as privileged and confidential, you should understand that when you provide the information about a potential case to Wilbanks & Bridges, we do not become your attorneys. With your permission, we may use your information to investigate whether we wish to represent you to bring a case. But until we both sign a written agreement, we do not represent you and have not agreed to do so.

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