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Weil, Gotshal & Manges LLP 

767 Fifth Avenue 

New York, NY 10153-0119

Exhibit C-1

Standard Proof of Claim Form

Case: 19-30088 Doc# 1784-5 Filed: 05/01/19 Entered: 05/01/19 15:32:50 Page 1

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 Official Form 410 Proof of Claim page 1

Official Form 410 

Proof of Claim 

Read the instructions before filling out this form. This form is for making a claim for payment in a bankruptcy case. Do not use this form to 

make a request for payment of an administrative expense. Make such a request according to 11 U.S.C. § 503. 

Filers must leave out or redact information that is entitled to privacy on this form or on any attached documents. Attach redacted copies of any 

documents that support the claim, such as promissory notes, purchase orders, invoices, itemized statements of running accounts, contracts, judgments, 

mortgages, and security agreements. Do not send original documents; they may be destroyed after scanning. If the documents are not available, 

explain in an attachment. 

A person who files a fraudulent claim could be fined up to $500,000, imprisoned for up to 5 years, or both. 18 U.S.C. §§ 152, 157, and 3571. 

Fill in all the information about the claim as of the date the case was filed. That date is on the notice of bankruptcy (Form 309) that you received.

Part 1: Identify the Claim 

1. Who is the current

creditor? ___________________________________________________________________________________________________________ 

Name of the current creditor (the person or entity to be paid for this claim) 

Other names the creditor used with the debtor ________________________________________________________________________

2. Has this claim been

acquired from

someone else?

 No

 Yes. From whom? ______________________________________________________________________________________________________

3. Where should notices

and payments to the

creditor be sent?

Federal Rule of

Bankruptcy Procedure

(FRBP) 2002(g)

Where should notices to the creditor be sent? Where should payments to the creditor be sent? (if 

different)

Contact phone ________________________

Contact email ________________________

Contact phone ________________________

Contact email ________________________

4. Does this claim amend

one already filed?

 No

 Yes. Claim number on court claims registry (if known) ________ Filed on ________________________

MM / DD / YYYY

5. Do you know if anyone

else has filed a proof

of claim for this claim?

 No

 Yes. Who made the earlier filing? _____________________________

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Case: 19-30088 Doc# 1784-5 Filed: 05/01/19 Entered: 05/01/19 15:32:50 Page 2

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Official Form 410 Proof of Claim page 2

Part 2: Give Information About the Claim as of the Date the Case Was Filed 

6. Do you have any number

you use to identify the

debtor?

 No

 Yes. Last 4 digits of the debtor’s account or any number you use to identify the debtor: ____ ____ ____ ____

7. How much is the claim? $_____________________________. Does this amount include interest or other charges? 

 No

 Yes. Attach statement itemizing interest, fees, expenses, or other

charges required by Bankruptcy Rule 3001(c)(2)(A).

8. What is the basis of the

claim?

Examples: Goods sold, money loaned, lease, services performed, personal injury or wrongful death, or credit card. 

Attach redacted copies of any documents supporting the claim required by Bankruptcy Rule 3001(c). 

Limit disclosing information that is entitled to privacy, such as health care information. 

______________________________________________________________________________

9. Is all or part of the claim

secured?

 No

 Yes. The claim is secured by a lien on property.

Nature of property:

 Real estate. If the claim is secured by the debtor’s principal residence, file a Mortgage Proof of Claim

Attachment (Official Form 410-A) with this Proof of Claim.

 Motor vehicle

 Other. Describe: _____________________________________________________________ 

Basis for perfection: _____________________________________________________________

Attach redacted copies of documents, if any, that show evidence of perfection of a security interest (for 

example, a mortgage, lien, certificate of title, financing statement, or other document that shows the lien has 

been filed or recorded.)

Value of property: $__________________

Amount of the claim that is secured: $__________________

Amount of the claim that is unsecured: $__________________ (The sum of the secured and unsecured 

amounts should match the amount in line 7.)

Amount necessary to cure any default as of the date of the petition: $____________________ 

Annual Interest Rate (when case was filed)_______% 

 Fixed

 Variable

10. Is this claim based on a

lease?

 No

 Yes. Amount necessary to cure any default as of the date of the petition. $____________________ 

11. Is this claim subject to a

right of setoff?

 No

 Yes. Identify the property: ___________________________________________________________________

Case: 19-30088 Doc# 1784-5 Filed: 05/01/19 Entered: 05/01/19 15:32:50 Page 3

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Official Form 410 Proof of Claim page 3

12. Is all or part of the claim

entitled to priority under

11 U.S.C. § 507(a)?

A claim may be partly

priority and partly

nonpriority. For example,

in some categories, the

law limits the amount

entitled to priority.

 No

 Yes. Check one: Amount entitled to priority 

 Domestic support obligations (including alimony and child support) under

11 U.S.C. § 507(a)(1)(A) or (a)(1)(B). $____________________

 Up to $2* of deposits toward purchase, lease, or rental of property or services for

personal, family, or household use. 11 U.S.C. § 507(a)(7). $____________________ 

 Wages, salaries, or commissions (up to $12,*) earned within 180 days before the

bankruptcy petition is filed or the debtor’s business ends, whichever is earlier.

11 U.S.C. § 507(a)(4).

$____________________ 

 Taxes or penalties owed to governmental units. 11 U.S.C. § 507(a)(8). $____________________ 

 Contributions to an employee benefit plan. 11 U.S.C. § 507(a)(5). $____________________ 

 Other. Specify subsection of 11 U.S.C. § 507(a)(__) that applies. $____________________ 

* Amounts are subject to adjustment on 4/01/1 and every 3 years after that for cases begun on or after the date of adjustment.

Part 3: Sign Below 

The person completing 

this proof of claim must 

sign and date it. 

FRBP 9011(b). 

If you file this claim 

electronically, FRBP 

5005(a)(2) authorizes courts 

to establish local rules 

specifying what a signature 

is.

A person who files a 

fraudulent claim could be 

fined up to $500,000, 

imprisoned for up to 5 

years, or both. 

18 U.S.C. §§ 152, 157, and 

3571. 

Check the appropriate box: 

 I am the creditor.

 I am the creditor’s attorney or authorized agent.

 I am the trustee, or the debtor, or their authorized agent. Bankruptcy Rule 3004.

 I am a guarantor, surety, endorser, or other codebtor. Bankruptcy Rule 3005.

I understand that an authorized signature on this Proof of Claim serves as an acknowledgment that when calculating the 

amount of the claim, the creditor gave the debtor credit for any payments received toward the debt. 

I have examined the information in this Proof of Claim and have a reasonable belief that the information is true 

and correct. 

I declare under penalty of perjury that the foregoing is true and correct. 

Executed on date _________________ MM / DD / YYYY

________________________________________________________________________

Signature 

Print the name of the person who is completing and signing this claim:

Name _______________________________________________________________________________________________

First name Middle name Last name 

Title _______________________________________________________________________________________________ 

Company _______________________________________________________________________________________________ 

Identify the corporate servicer as the company if the authorized agent is a servicer.

Address _______________________________________________________________________________________________

Number Street

_______________________________________________________________________________________________

City State ZIP Code

Contact phone _____________________________ Email ____________________________________

Case: 19-30088 Doc# 1784-5 Filed: 05/01/19 Entered: 05/01/19 15:32:50 Page 4

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Instructions for Proof of Claim 

United States Bankruptcy Court 12/15 

These instructions and definitions generally explain the law. In certain circumstances, such as bankruptcy cases that debtors do 

not file voluntarily, exceptions to these general rules may apply. You should consider obtaining the advice of an attorney, 

especially if you are unfamiliar with the bankruptcy process and privacy regulations.

How to fill out this form

 Fill in all of the information about the claim as 

January 29, 2019.

 Fill in the caption at the top of the form.

 If the claim has been acquired from someone else, 

then state the identity of the last party who owned the

claim or was the holder of the claim and who transferred it 

to you before the initial claim was filed. 

 Attach any supporting documents to this form.

Attach redacted copies of any documents that show that the

debt exists, a lien secures the debt, or both. (See the

definition of redaction on the next page.) 

Also attach redacted copies of any documents that show

perfection of any security interest or any assignments or

transfers of the debt. In addition to the documents, a

summary may be added. Federal Rule of Bankruptcy

Procedure (called “Bankruptcy Rule”) 3001(c) and (d). 

 Do not attach original documents because 

attachments may be destroyed after scanning.

 If the claim is based on delivering health care goods 

or services, do not disclose confidential health care 

information. Leave out or redact confidential 

information both in the claim and in the attached 

documents.

 A Proof of Claim form and any attached documents 

must show only the last 4 digits of any social security 

number, individual’s tax identification number, or 

financial account number, and only the year of any 

person’s date of birth. See Bankruptcy Rule 9037. 

 For a minor child, fill in only the child’s initials and 

the full name and address of the child’s parent or 

guardian. For example, write A.B., a minor child (John

Doe, parent, 123 Main St., City, State). See Bankruptcy

Rule 9037. 

Confirmation that the claim has been filed

To receive confirmation that the claim has been filed, either 

enclose a stamped self-addressed envelope and a copy of this 

form. You may view a list of filed claims in this case by 

visiting the Claims and Noticing Agent's website at

https://restructuring.primeclerk.com/pge. 

Understand the terms used in this form

Administrative expense: Generally, an expense that arises

after a bankruptcy case is filed in connection with operating,

liquidating, or distributing the bankruptcy estate. 

11 U.S.C. § 503. 

Claim: A creditor’s right to receive payment for a debt that the 

debtor owed on the date the debtor filed for bankruptcy. 11 

U.S.C. §101 (5). A claim may be secured or unsecured. 

Creditor: A person, corporation, or other entity to whom a

debtor owes a debt that was incurred on or before the date the

debtor filed for bankruptcy. 11 U.S.C. § 101 (10). 

Debtor: A person, corporation, or other entity who is in

bankruptcy. Use the debtor’s name and case number as shown in 

the bankruptcy notice you received. 11 U.S.C. § 101 (13). 

Evidence of perfection: Evidence of perfection of a security

interest may include documents showing that a security interest 

has been filed or recorded, such as a mortgage, lien, certificate of 

title, or financing statement. 

Information that is entitled to privacy: A Proof of Claim form 

and any attached documents must show only the last 4 digits of 

any social security number, an individual’s tax identification 

number, or a financial account number, only the initials of a 

minor’s name, and only the year of any person’s date of birth. If 

a claim is based on delivering health care goods or services, limit 

the disclosure of the goods or services to avoid embarrassment 

or disclosure of confidential health care information. You may 

later be required to give more information if the trustee or 

someone else in interest objects to the claim.

A person who files a fraudulent claim could be fined up 

to $500,000, imprisoned for up to 5 years, or both.

18 U.S.C. §§ 152, 157 and 3571. 

Case: 19-30088 Doc# 1784-5 Filed: 05/01/19 Entered: 05/01/19 15:32:50 Page 5

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Priority claim: A claim within a category of unsecured claims 

that is entitled to priority under 11 U.S.C. § 507(a). These 

claims are paid from the available money or property in a 

bankruptcy case before other unsecured claims are paid. 

Common priority unsecured claims include alimony, child 

support, taxes, and certain unpaid wages.

Proof of claim: A form that shows the amount of debt the

debtor owed to a creditor on the date of the bankruptcy filing.

The form must be filed in the district where the case is pending. 

Redaction of information: Masking, editing out, or deleting

certain information to protect privacy. Filers must redact or

leave out information entitled to privacy on the Proof of

Claim form and any attached documents. 

Secured claim under 11 U.S.C. § 506(a): A claim backed by

a lien on particular property of the debtor. A claim is secured

to the extent that a creditor has the right to be paid from the

property before other creditors are paid. The amount of a

secured claim usually cannot be more than the value of the

particular property on which the creditor has a lien. Any

amount owed to a creditor that is more than the value of the

property normally may be an unsecured claim. But exceptions

exist; for example, see 11 U.S.C. § 1322(b) and the final

sentence of § 1325(a). 

Examples of liens on property include a mortgage on real

estate or a security interest in a car. A lien may be voluntarily

granted by a debtor or may be obtained through a court

proceeding. In some states, a court judgment may be a lien. 

Setoff: Occurs when a creditor pays itself with money

belonging to the debtor that it is holding, or by canceling a debt 

it owes to the debtor.

Unsecured claim: A claim that does not meet the

requirements of a secured claim. A claim may be unsecured in

part to the extent that the amount of the claim is more than the

value of the property on which a creditor has a lien. 

Offers to purchase a claim

Certain entities purchase claims for an amount that is less than

the face value of the claims. These entities may contact

creditors offering to purchase their claims. Some written

communications from these entities may easily be confused

with official court documentation or communications from the

debtor. These entities do not represent the bankruptcy court,

the bankruptcy trustee, or the debtor. A creditor has no

obligation to sell its claim. However, if a creditor decides to

sell its claim, any transfer of that claim is subject to

Bankruptcy Rule 3001(e), any provisions of the Bankruptcy

Code (11 U.S.C. § 101 et seq.) that apply, and any orders of

the bankruptcy court that apply. 

Please send completed Proof(s) of Claim to:

If by first class mail:

PG&E Corporation Claims Processing Center 

c/o Prime Clerk LLC 

Grand Central Station, PO Box 4850 

New York, NY 10163-4850 

If by overnight courier or hand delivery: 

PG&E Corporation Claims Processing Center 

c/o Prime Clerk LLC 

850 Third Avenue, Suite 412 

Brooklyn, NY 11232 

You may also hand deliver your completed Proof(s) of 

Claim to any of the following service center offices (during 

the hours of 8:30 a.m. – 5:00 p.m. Pacific Time): 

Chico Service Center 

350 Salem Street 

Chico, CA 95928 

Marysville Service Center 

231 “D” Street 

Marysville, CA 95901 

Napa Service Center 

1850 Soscol Ave. Ste 105 

Napa, CA 94559 

Oroville Service Center 

1567 Huntoon Street 

Oroville, CA 95965 

Redding Service Center 

3600 Meadow View Road 

Redding, CA 96002 

Santa Rosa Service Center 

111 Stony Circle 

Santa Rosa, CA 95401 

Photocopy machines will not be available at the Claim 

Service Centers; you must bring a copy of your claim if you 

wish to receive a date-stamped conformed copy. 

Do not file these instructions with your form

Case: 19-30088 Doc# 1784-5 Filed: 05/01/19 Entered: 05/01/19 15:32:50 Page 6

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