Oil Spill Claim Evaluation – Business – Emerald Coast Loss Claims

Name *

First

Last

Email *

Phone *

Date of Birth *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Business Name *

What Zone did you live or work in at the time of the Oil Spill (April 20, 2010)? If unknown, please use the following mapping tool. http://69.166.140.73/zonelocatoreconomic/ *

Zone A
Zone B
Zone C
Zone D
Neither
Don't Know

Did you own property in a qualifying Zone at the time of the Oil Spill? If so, which Property Zone? If unknown, please use the following mapping tool. http://69.166.140.73/zonelocatoreconomic/ *

Coastal Wetlands
Wetlands Real Property
Real Property Sales
Neither
Don't Know

What category of claim(s) do you have? *

Seafood Compensation Program
Individual Economic Loss
Individual Periodic Vendor or Festival Vendor
Coastal Real Property Damage
Wetlands Real Property Damage
Real Property Sales Loss
Subsistence Loss
Vessels of Opportunity (VoO) Charter Payment
Vessel Physical Damage
Medical Claims
Other

Please Specify *

If Seafood, did you file a claim with the DHECC prior to the January 22, 2012 deadline? *

Was your employment in any of the following excluded industries? *

Financial Institutions
Funds, Financial Trusts, or other Financial Vehicles
Gaming
Insurance Entities
Oil & Gas Industry
Defense Contractors/Subcontractors
Real Estate Developer
Selling or Marketing BP branded fuel
Governmental Organization
Menhaden/Pogy fishing, processing, selling, catching, or harvesting.
Industry affected buy offshore drilling Moratorium

Gross Income for 2006 *

Gross Income for 2007 *

Gross Income for 2008 *

Gross Income for 2009 *

Gross Income for 2010 *

Gross Income for 2011 *

Gross Income for 2012 *

Estimated Losses *

How Calculated *

Please provide a brief description of type of claim and damages: *

Did you file a claim with the Gulf Coast Claims Facility (GCCF)? *

GCCF Claimant Number *

Total Amount Received from the GCCF: *

Did You Sign a Release? *

Have you filed a claim with the Deepwater Horizon Economic Claims Center (DHECC)? *

DHECC Claimant Number *

Total Amount Received from the DHECC: *

Did you sign a Release? *

Did you file an Opt-Out Request prior to November 1, 2012 *

Did you file a request to Revoke your Opt-Out? *

Have you filed a claim with the BP OPA Claims Center? *

Has another attorney or law firm represented you for your claim(s) *

Has the other attorney/law firm been released from this matter? *

Has the other attorney/law firm asserted a lien on your settlement? *

Yes
No
Unknown

Other attorney/law firm name *

Helping Victims of the BP Oil Spill

Oil Spill Claim Evaluation – Business

INDIVIDUALS
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BUSINESSES
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Helping Victims of the BP Oil Spill

Oil Spill Claim Evaluation – Business

INDIVIDUALSCLICK HERE

BUSINESSESCLICK HERE

INDIVIDUALS
CLICK HERE

BUSINESSES
CLICK HERE