Page 149 - claims information pack ebook_e
P. 149
Example Claim Form - Instructions
How to fill in your claim form
Please read these notes carefully. Selecting a claim Category
This claim form is in three parts. You must The 1992 Fund places claims for damage caused
complete and return each part: by oil pollution into one of five categories. If you
Part 1 have a claim in one or more of the categories, you
Details of the claimant – person(s), business, should complete the corresponding section(s) of
government department or State making the claim. the claim form:
Part 2 Section to
Details of the claim – loss and/or damage suffered Claim Category complete
as a result of the contamination. Please select
the appropriate claim category (see below) and Costs of clean up and Section A
4 preventive measures
complete the section(s) which is (are) relevant to
your claim(s). You must complete the form for each Property damage
business for which you are claiming. Please use the (eg cleaning, repairing or
checklists provided for each claim category. replacing property that has Section B
been contaminated by oil such
Part 3 as the hulls of vessels)
Declaration – claimants are required to make
a declaration that their claims are a true and Economic loss in the fisheries,
accurate reflection of their losses. The shipowner’s mariculture and fish processing Section C
insurer and the 1992 Fund take the presentation sectors
of fraudulent documentation seriously and if they
become aware that fraudulent documentation has Economic loss in the tourism
been submitted in support of a claim, they reserve sector and other related Section D
businesses
the right to inform the appropriate national authority.
By signing the declaration, claimants are deemed Other losses including costs
to have agreed to the disclosure of the information of reasonable measures to Section E
reinstate the environment
contained within the claim form and any supporting and post-spill studies
evidence to the parties involved with the payment
of compensation, namely to the shipowner’s insurer SUMMARY OF SCOPE OF COMPENSATION
and the 1992 Fund, their experts and the Limitation AVAILABLE FOR EACH CATEGORY OF CLAIM
Court which has jurisdiction for this incident. A - Costs of clean up and preventive
measures
Claimants are required to sign this declaration
which is to be found at the end of the claim form Compensation is payable for the costs of
(part 3). Your claim will not be considered if reasonable measures taken to:
this declaration is not signed. If submitting your ● Mobilise clean-up equipment/response resources;
claim electronically, you should print and sign the ● Monitor the oil spill;
declaration before scanning and attaching it to ● Combat oil at sea;
your claim. The original signed declaration should ● Protect resources vulnerable to oil;
also be sent by post together with any original ● Clean shorelines/coastal installations;
supporting documentation you may be providing. ● Provide local reception facilities for cleaning,
