CLAIMS VERIFICATION BOARD
ROUTING FORM
PURPOSE: To give the person seeking a refund or repayment a procedure which lays out what he is supposed to do.
NOTE TO THE CLAIMANT: This form is provided to assist you. It is designed so that you can take it, in hand, and do the steps and see each person in the order listed. This will ensure that each of the steps of your claim is swiftly expedited. It is your responsibility to see that this form is properly executed and filled out and mailed to the Claims Verification Board.
If you need any help or guidance in getting this routing form done, please consult the org Keeper of Tech (or LRH Communicator) who will help you.
DIRECTIONS:
SIGNING: When a step is done, you place your initials on the line to the right of the step.
ALTERNATE TERMINALS: If a post listed on this form is not filled or the person is absent from post, the senior or alternate terminal does the actions as if he were the post holder and marks the appropriate box.
1. CLAIMANT
a
.
Read the PURPOSE, NOTE and DIRECTIONS above.
b. Fill in (PLEASE PRINT CLEARLY):
NAME ___________________________________________________________
ADDRESS _________________________________________________________
STATE/PROVINCE ______________________ COUNTRY ___________________
POSTAL CODE __________________________PHONE _____________________
AMOUNT OF REPAYMENT REQUESTED ___________________________
NAME OF ANY FSM(S) WHO FSMed YOU FOR ANY SERVICE(S) YOU ARE
REQUESTING A REFUND/REPAYMENT FOR:
_________________________________________________________________
c. Carefully read and ensure you fully understand the attached "Claimant
Information
Sheet."
d
.
Go to the Chaplain in Division 6.
Date: ______ Time: ______
2. CHAPLAIN DIVISION 6 or
____ Ruds Survey & Research I/C or ____ Ruds Auditor or
____Other
a. Receive from the Chaplain, or person attending you, the handling specified in the
attached
checklist.
b. When all handlings are complete and if you no longer wish a Refund/Repayment,
terminate this routing form per the INCORRECT/UNCOMPLETABLE ROUTING
FORM instructions at the end.
Unpublished work; — 2006 CSI. All Rights Reserved. The names, addresses and phone numbers on a Church's mailing list are deemed to be proprietary information of that Church of Scientology. Any publication or dissemination of any portion of the mailing 1ist (even giving out individual names addresses or phone number is a violation of the law and may be prosecuted.
c. If you still wish a Refund/Repayment after handlings received, do the following:
Get a signed statement of what handlings the Chaplain (or person acting as a
Chaplain)
did with you.
d. Ensure you have all invoices, cancelled checks, and receipts or good xeroxes or
Photostats
thereof.
e. Write out (in duplicate) and sign the following statements:
“I have not already been given a refund or repayment on this matter.” (Get
t
his
statement notarized.)
“I understand that I cannot, by reason of refund or repayment, obtain further service from orgs, missions or individuals and may not have upper level services."
-
I
understand there is an administrative charge for the claim.”
f. Bring the signed statements and your copies of all invoices, cancelled checks, and
receipts or good xeroxes or photostats to the Treasury Secretary.
Date: ______ Time: ______
3. TREASURY SECRETARY
DIVISION 3 or
____ Board Finance Officer ____ OES or ____ person acting as Treas
Sec
a. Present your signed statements and all required documents as covered in the
Claimant Information Sheet to the Treasury Secretary. (Keep copies of each for
later
on this routing form.)
b. Get from the Treasury Secretary the following signed statements:
Statement of the Technical Secretary that the service has not been delivered, or how much has been delivered.
Statement from the Qualifications Secretary that the person has received or has refused correction.
S
tatements
from the Finance Banking Officer that the check(s) for the
service(s) were never cancelled and that they were collected, or
that the money, if cash, was actually received and not returned.
c. Put the Invoices, cancelled checks, receipts, statements and this routing form in
an
envelope.
d. Affix the correct postage to the envelope and mail it to:
Claims Verification Board
Church of Scientology International
6331 Hollywood Boulevard, Suite 801
Hollywood,
California 90028-6300, USA
(Note: Do not: send by registered mail as this violates Church policy, HCO PL 26 May 65 II, COMMUNICATIONS, REGISTERED MAIL.)
Date: ______ Time: ______
3. TREASURY SECRETARY
DIVISION 3 or
____ Board Finance Officer ____ OES or ____ person acting as Treas
Sec
3. TREASURY SECRETARY
DIVISION 3 or
____ Board Finance Officer ____ OES or ____ person acting as Treas
Sec
4. CLAIMS VERIFICATION BOARD
a
.
Process the claim per Claims Verification Board policies.
b
.
If approved, work out the administrative charge.
AMOUNT: _______________________
c. Inform both tile claimant and the FBO by mail that the claim has been approved
and
what the administrative charges are.
d. If the claim is disapproved, inform in writing both the FBO and the claimant.
Include instructions on what needs to be done to get the approval, if this is the
case.
e
.
Send the routing form back to the claimant.
Date: ______ Time: ______
4. CLAIMANT
Upon return of the routing form, read any communication included from the Claims Verification Board.
Take the routing form and any despatches from the Claims Verification Board and go see the Ethics Officer.
Date: ______ Time: ______
3. ETHICS OFFICER
DIVISION 1 or
____ Dir of Inspections & Reports or _____ HAS
a
.
Request the Ethics Officer to do the actions per the attached
checklist
b. Have the Ethics Officer sign his attest below that you have filled out and signed
the Release, Waiver and Writ of Expulsion.
ETHICS OFFICER ATTEST: _______________________________________
c
.
Go to the Treasury Secretary.
Date: ______ Time: ______
3. TREASURY SECRETARY
DIVISION 3 or
____ Board Finance Officer ____ OES or ____ person acting as Treas
Sec
a
.
Show the Treasury Secretary the Ethics Officer attest at step 6b
above.
b
.
Request that the Treasury Secretary do the actions per the attached
checklist.
c. Hand the completed routing form and all attachments to the Treasury Secretary.
Date: ______ Time: ______
END OF ROUTING FORM
ASSISTANCE: If you have difficulty in getting through this routing form, mark the box to the left and take this form to the HCO Executive Secretary for assistance.
COMPLETED ROUTING FORM: Mark the box to the left. Route it and any attachments to the Director of Inspections & Reports for filing in the Valuable Documents File.
INCORRECT/UNCOMPLETABLE ROUTING FORM: Mark the box to the left. Route the routing form and any attachments to the Director of Inspections & Reports for filing in the person's Ethics Files.
If not completed, mark the reason for terminating this routing form:
Wrong routing form
Other reason
NOTE: If you encounter any difficulties in using this routing form or need any assistance in proper use of routing forms, please contact the Senior Routing Forms I/C Int.
SCIENTOLOGY, FLAG, HCO and LRH are trademarks and service marks owned by Religious Technology Center and are used with its permission.
ATTACHMENT 1
CHECKLIST OF STAFF ACTIONS
PLEASE SIGN OFF THE LINE AT THE END OF EACH STEP AS AN
ATTEST THAT YOU HAVE DONE THE ACTIONS CALLED FOR.
CHAPLAIN'S ACTIONS:
(HCO PL 6 May 84, ARC BREAK PROGRAM, ADDITIONAL DATA)
Get a C/S 53 or Green Form assessed on the person or any other handling as needed. ______
(HCO PL 9 Nov. 74R, REFUNDS AND REPAYMENTS) Liaise with the Tech Sec if needed to get this done.
As needed, carry out any of the actions covered in the following LRH references to help handle the person's ARC break.
HCO PL 6 May 84, ARC BREAK PROGRAM, ADDITIONAL DATA
HCO PL 9 Nov. 74R, REFUNDS AND REPAYMENTS
HCO PL 25 June 72, RECOVERING STUDENTS AND PCs
HCO PL 31 Dec. 59R, BLOW-OFFS
HCOB 7 Sept. 64 II, PTPs, OVERTS AND ARC BREAKS
HCO PL 2 Mar. 84RB, O/W WRITE-UPS
HCO PL 15 Nov. 74 II, CFs, ARC BREAKS IN
HCOB 20 Apr. 72 II, PRODUCT PURPOSE AND WHY AND W/C ERROR CORRECTION
HCOB 15 Nov. 74R, STUDENT REHABILITATION LIST
HCO PL 9 Apr. 72R, CORRECT DANGER CONDITION HANDLING
HCO PL 11 Apr. 72, FURTHER DATA ON CORRECT DANGER CONDITION HANDLING
HCO PL 3 May 72RA, ETHICS AND EXECUTIVES
The Conditions Formulas in the book Introduction to Scientology Ethics pages 93-119
HCO PL 3 Aug. 85, COMPLETING CONDITIONS FORMULAS
HCO PL 2 Nov. 82, CONDITIONS HANDLINGS
HCO PL 19 Dec. 82RA II, REPAIRING PAST ETHICS CONDITIONS
HCOB 31 Dec. 78RB II, OUTLINE OF PTS HANDLING
HCOB 31 Dec. 78RA III, EDUCATING THE POTENTIAL TROUBLE SOURCE, THE FIRST STEP TOWARD HANDLING: PTS C/S-1
HCO PL 5 Apr. 72RD, PTS TYPE A HANDLING
HCOB 1 Apr. 81RA, INTERVIEWS
HCOB 8 Mar. 83, HANDLING PTS SITUATIONS
HCO PL 27 Jan. 80 II, RUDIMENTS (ARC BREAK) PROGRAM ______
If fully handled, escort the person to the correct terminal to continue any incomplete service or to the Registrar to sign up for his next service.
______
CONDITIONAL: If the person still wishes a refund or repayment, do the actions below. Write up and sign a statement on what actions have been done and give it to the claimant, and take the person to the Treasury Secretary.
______
TREASURY SECRETARY'S ACTIONS:
Receive from the person his invoices, cancelled checks and receipts or good xeroxes or photostats thereof. ______
Look into the person's accounts file and into the invoices to ensure that there is no debit or corrective invoice after that date for this person and that the invoice and receipt in the claim are correct. ______
Get the Technical Secretary to write and sign a statement that the service has not been delivered or how much has been delivered. ______
Get the Qualifications Secretary to write and sign a statement that the claimant has received or has refused correction. ______
Forward the matter, with all papers, to the FBO or person acting in that capacity. ______
Get a signed statement from the FBO that the check was never cancelled and that it was collected or that the money, if cash, was actually received and not returned. ______
Let the FBO know it is mandatory to set aside a sum of money equivalent to the claim in the CVB Account or in a special account to hold it for any future payment if the claim is fully verified by the CVB. Get from the FBO an attest that the money has been set aside. ______
Give the signed statements from the Tech Sec, Qual Sec and FBO, and the up-to-date accounts statement to the claimant to include with the rest of his papers. ______
Assist the claimant as needed and ensure he sends all receipts, invoices, cancelled checks and statements to the CVB. ______
Note: At this point, the claimant mails his claim to the CVB to examine it for correctness. Once verified, the CVB will notify both the org and the claimant. The routing form will be sent to the claimant by the CVB.
ETHICS OFFICER'S ACTIONS:
Have the person sign the Release, Waiver and Writ of Expulsion per HCO PL 9 Nov. 74R, REFUNDS AND REPAYMENTS. ______
File the Waiver in Valuable Documents-this is for the org's protection.
______
TREASURY SECRETARY'S ACTIONS:
Disburse the amount authorized by CVB for the refund/repayment.
______
Take the routing form from the person and escort him to Reception.
______
Send the administrative charge to the Claims Verification Board. ______
Check for the name(s) of the FSM(s) who selected the claimant. Despatch the FSM I/C with the details of the refund/repayment, and ensure that the FSM(s) is/are handled per HCO PL 5 Apr. 79 I, FSM PENALTY FOR REFUNDS, REPAYMENTS AND BOUNCED CHECKS. ______
Go to the end of the claimant's routing form and fill out the date and time lines in Section 7. Look at the end of the routing form, and terminate the routing form per the COMPLETED or INCOMPLETE ROUTING FORM instructions. ______
END OF STAFF CHECKLIST
SCIENTOLOGY, HCO and LRH are trademarks and service marks owned by Religious Technology Center and are used with its permission.
ATTACHMENT 2
CLAIMANT INFORMATION SHEET
This form is provided to facilitate smooth and eventual satisfactory handling of Refund and Repayment requests.
A REFUND IS A RETURN OF MONIES AFTER SERVICE.
A REPAYMENT IS A RETURN OF MONIES WITHOUT THE SERVICE BEING TAKEN.
It is good policy to ensure that claims are swiftly expedited. It helps the claimant and it helps the organization.
This information sheet outlines the procedure one uses in obtaining the refund or repayment being requested. Experience in handling both proper and faulty claims over the years has helped to develop this system.
The following information is given for your assistance.
NOTE: IF YOU HAVE BEEN REFUSED AUDITING OR TRAINING BY A CHURCH AND HAVE JUST PAID YOUR MONEY, YOU DO NOT HAVE TO FILL IN THE FORM TO GET A RETURN OF YOUR MONEY. YOU WILL HAVE A REPAYMENT OF THE MONEY RETURNED TO YOU AT ONCE. THE CHAPLAIN WILL ASSIST YOU WITH THIS.
No REFUND may be applied for after three months from the end of the last service rendered. This means that a refund applied for three months after the end of an intensive's last auditing session or last day of attendance on a course may not be granted.
YOU, THE CLAIMANT, MUST MAKE EVERY VISIT YOURSELF, WITH FORM IN HAND, TO THE PERSON/POST GIVEN ON THE ROUTING FORM. This is to help you and the organizational staff in expediting your request.
There have been many faulty claims received, so please make sure your information is clear and accurate. Such accurate and correct information attached to your claim will aid the Church in speedily processing your claim. Not having the correct information can complicate the process and slow your claim.
Over the years it has been found that many people applying for refund or repayment discover that they do not want them. The reasons are many and varied, but few people really wish to cut themselves off from the help that Scientology applied religious philosophy can give them. If, while in the process of obtaining your refund or repayment, you decide that you do not wish to continue with it, please immediately inform the Chaplain or whoever is helping you get through this routing form.
In doing this routing form, be sure to fill in the form and the attachments in duplicate. When you have completed the routing form, give a copy to the Finance Enforcement Officer (or FBO) for your accounts file in the org. Put the original (ensuring it is very legible) in a package and send it to the Claims Verification Board.
The documents that are required by the Claims Verification Board, to be included in the self-addressed envelope, are listed here for your convenience:
Invoices, cancelled checks and receipts or good xeroxes or photostats thereof.
A copy of your up-to-date account statement from the org.
Written and signed statements from all staff members you visit on the routing form explaining what actions they took with you.
A written statement notarized, that no refund or repayment has already been given on this matter.
A statement from the Technical Secretary that the service has not been delivered, or, how much has been delivered.
A statement from you stating you understand that by reason of refund or repayment, you cannot obtain further service from orgs, missions or individuals and may not have upper level services.
A statement that you understand that there is an administrative charge for processing the claim. (This charge will not exceed 3% of the claim.)
The Claims Verification Board has been set up by the Church to verify that claims meet all policy requirements and to see that claims are actually processed correctly and swiftly. The procedure enables you to gather all the necessary data in a speedy fashion and present it in a readily understood form. In this fashion, you do not have to rely on others for the completion of your claim.
CLAIMS VERIFICATION BOARD SECRETARY
Unpublished work: — 1988, 1991, 2006 CSI. All Rights Reserved. SCIENTOLOGY is a trademark and service mark owned by Religious Technology Center and is used with its permission.