Page 160 - claims information pack ebook_e

Section A

Example Claim Form
Claim Number (for internal use only) PART 2 Section A
Costs of clean up and preventive measures

For large items of expenditure such as vessels or aircraft, treatment of waste, establishment of wildlife
treatment centres, or removal of oil from wrecks, please see the separate lists at the end of this section
which detail the type of information required.
You may wish to use the following tables as examples of the type of information required, in respect
of equipment owned, used or hired for the clean up and response operations. Templates of similar tables
and spreadsheets are available to download from the IOPC Funds website.
A Equipment owned by the claimant (type of equipment, purchase cost and residual value, transport costs,
daily rate and period of use)

Description Transport costs Period of use (days) Total
of Date of Purchase Residual Cost
equipment purchase cost value after Daily rate Mon Tue Wed Thur Fri
owned use Delivery Return etc.
3rd 4th 5th 6th 7th
In
use
Standby
In
use 15
Standby
6A - Total
B Equipment rented/hired from third parties (type of equipment, cost of transport, cost and duration of use)

Transport costs Total
Description Date of (if applicable) Daily hire Period of use (days) Cost
of equipment hire
rented/hired Delivery Return rate Mon Tue Wed Thur Fri etc.
3rd 4th 5th 6th 7th
In
use
Standby
In
use
Standby
6B - Total

C Equipment purchased by the claimant (type of equipment purchased, cost and duration of use, cost of transport)
Description Equipment held Period of use (days) Total
of Date of Purchase Unit Resale Transport Cost
equipment purchase cost Cost value after costs in stock/issued Mon Tue Wed Thur Fri
purchased use (delivery) for use etc.
3rd 4th 5th 6th 7th
In
stock
Issued
for use
In
stock
Issued
for use
6C - Total

7) If any equipment has been damaged during the clean-up operations or preventive measures undertaken,
indicate circumstances of the damage, cost of repair/refurbishment or replacement of the item.