Page 153 - claims information pack ebook_e

Example Claim Form

Submitting a claim – step by step.

Have you suffered pollution damage from
a tanker in a 1992 Fund Member State?

YES

Complete Part 1 of the claim form.

Select which category(ies) your claim falls under and
complete the corresponding section(s) of Part 2.

Compile all supporting documents available.
8

Print and sign the declaration in Part 3.

How have you completed the form?

Electronically Manually

Send parts 1, 2 and a scanned copy
of the signed declaration from Post parts 1, 2 & 3 to the address
part 3 to the email address provided on page 7 * .
provided on page 7.

Wait for acknowledgement of receipt and Claim Number(s) to be sent to you.

Once you have compiled all required
supporting documents, label each Once you have compiled the
of them with your claim number(s) required original supporting
and send any electronic files to documents, clearly label these with
the email address and any original your claim number(s) and post to
documents, together with the the address provided on page 7.
original signed part 3, to the postal
address, both provided on page 7.

Use your claim number in any future correspondence.

* If you have access to a scanner, please scan all items and send to the email address provided on page 7 before posting.