Page 182 - claims information pack ebook_e

Example Claim Form
Claim Number (for internal use only) PART 2 Section E Section E
Other Losses

Summary of your claim

Part 1 – Cost of studies to establish the nature and extent of the damage caused to the environment by the oil
spill and to determine whether or not reinstatement measures are necessary and feasible

Has a post-spill study been undertaken prior to the measure being undertaken? Yes No

1) Date and scope (Terms of Reference) of the study

2) Description of the work carried out

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3) Relationship between the study and the reinstatement measure

4) Breakdown of the cost of the study
a. Cost of personnel (number and categories, hours and rate)

b. Type of material used (cost and duration of use)

c. Equipment used (cost and duration of use)

5) Other costs/expenses (including laboratory costs)

Calculation of the total amount of the claim
You may wish to use the following table as an example of how to calculate the total amount of the claim.
Whichever method you use, you must provide an explanation of the method you have used to calculate the total
amount of the claim.
Item 4(A): Cost of personnel +

Item 4(B): Cost of material used +
Item 4(C): Cost of equipment used +
Item 5: Other costs/expenses +
Total =