Get the free Claim Form

This Claim Form is for Settlement Class Members who suffered economic harm due to the release of chemicals from the Altuglas chemical plant in Bristol, Pennsylvania into the Delaware River in March 2023. Members can claim a Base Payment and additional compensation for proven economic losses related to this incident.

How to fill out claim form

How to fill out claim form

1. Obtain the claim form from the relevant insurance company or agency.
2. Read the instructions carefully before filling it out.
3. Fill in your personal information, including name, address, and contact details.
4. Provide the details of the incident or reason for the claim.
5. Attach any required documentation, such as receipts, reports, or photos.
6. Review the completed form for accuracy and completeness.
7. Sign and date the form.
8. Submit the claim form by mail or as instructed, ensuring to keep a copy for your records.

Who needs claim form?

1. Individuals who have experienced a loss or damage and are seeking compensation.
2. Policyholders who wish to claim benefits under their insurance policy.
3. Business owners needing to recover losses due to an insurable event.

For pdfFiller’s FAQs

How do I make edits in claim form without leaving Chrome?

Download and install the pdfFiller Google Chrome Extension to your browser to edit, fill out, and eSign your claim form, which you can open in the editor with a single click from a Google search page. Fillable documents may be executed from any internet-connected device without leaving Chrome.

Can I create an electronic signature for signing my claim form in Gmail?

It's easy to make your eSignature with pdfFiller, and then you can sign your claim form right from your Gmail inbox with the help of pdfFiller's add-on for Gmail. This is a very important point: You must sign up for an account so that you can save your signatures and signed documents.

Can I edit claim form on an iOS device?

You certainly can. You can quickly edit, distribute, and sign claim form on your iOS device with the pdfFiller mobile app. Purchase it from the Apple Store and install it in seconds. The program is free, but in order to purchase a subscription or activate a free trial, you must first establish an account.

What is claim form?

A claim form is a document that individuals or businesses use to request payment or compensation from an insurance company, employer, or other entities for covered expenses or losses.

Who is required to file claim form?

Typically, individuals or entities who have incurred a loss or expense and seek reimbursement from their insurance provider or another responsible party are required to file a claim form.

How to fill out claim form?

To fill out a claim form, provide accurate personal information, describe the incident or loss, include relevant dates, attach supporting documentation such as receipts or reports, and sign the form.

What is the purpose of claim form?

The purpose of a claim form is to formally initiate the process of requesting compensation or benefits for a specific loss, injury, or expense covered by a policy or agreement.

What information must be reported on claim form?

Information that typically must be reported includes claimant's personal details, description of the claim, date and time of the incident, type of loss, and any supporting documentation.