Page 171 - claims information pack ebook_e

Example Claim Form
PART 2 Section C Claim Number (for internal use only)
Economic loss in the fisheries, mariculture
and fish processing sectors
Section C

Summary of your claim
1) Brief description of the type of activity/operation conducted e.g. fishing/mariculture/fish processing:

2) Brief description of the loss claimed

3) Results of laboratory analysis and/or other evidence linking the oil pollution with the ship(s) involved in the incident

4) Type and size of vessel used (if applicable)

26 5) Name of vessel, and fishing licence/registration number (if applicable)

6) Cooperative/fishing association membership (if applicable)

7) Name of owner of fishing/mariculture/fish processing business

8) Is the claimant the sole owner of the business/vessel/operation detailed above? Yes No

If NO, indicate who owns the business/vessel/operation and the nature of the relationship to the claimant

9) Is the claimant's business or operation subject to an administrative ban as a result of the incident? Yes No
If YES, indicate the nature and date of this ban (start and finish)

10) Is your business subject to a quota? Yes No

If YES, please provide further details

11) Location of your homeport and fishing grounds/operation/usual place of business. Please also provide
separately the location on a map or chart giving co-ordinates.

12) Details of the species usually caught/produced/harvested/processed

13) Details of any alternative fishing ground(s) in which you operated during the ban