L sheet(s) if OMB NO. necessary. See reverse side for additional instructions. 1105-0008 1. Submit To Appropriate Federal Agency: 2. Name, Address of claimant and claimant's personal representative, if any. (See instructions on reverse.) (Number, street, city, State and Zip Code) 3. TYPE OF EMPLOYMENT 4. DATE OF BIRTH 5. MARITAL STATUS 6. DATE AND DAY OF ACCIDENT MILITARY 7. TIME (A.M. or P.M.) CIVILIAN 8. Basis of Claim (State in detail the known facts and circumstances attending the dama.
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How to fill out the Filiable online
Filling out the Filiable form for claims can be a critical step in addressing damage, injury, or death incidents. This guide will provide you with clear, step-by-step instructions to accurately complete the form online, ensuring you have all necessary information ready for successful submission.
Follow the steps to complete your claim form accurately.
- Click the ‘Get Form’ button to access the form and open it in your online editor.
- Select the appropriate federal agency to which your claim should be submitted by providing the agency's name in the designated field.
- Input your name and address, along with the information of your personal representative if applicable. This should include your number, street, city, state, and zip code.
- Specify your type of employment (military or civilian) and fill in your date of birth.
- Indicate your marital status and the date and day of the accident. Ensure this information is accurately provided.
- Record the exact time of the accident in either AM or PM format.
- In the basis of the claim section, thoroughly describe the known facts and circumstances of the incident, including any persons and property involved; location; and cause.
- If property damage occurred, provide the name and address of the owner, if not you. Briefly describe the property and the extent of the damage, along with the location for inspection.
- For personal injury or wrongful death claims, detail the nature and extent of each injury or cause of death, and if applicable, state the name of the injured person or decedent.
- List any witnesses along with their names and addresses.
- Specify the amount of your claim in dollars for property damage, personal injury, and wrongful death separately. Ensure all amounts are clearly noted to avoid any forfeiture of rights.
- Certify your claim by signing the form in the designated area, providing your phone number, and indicating the date of the claim.
- Once all fields are completed, you can review your form for accuracy before saving changes, downloading, printing, or sharing it as needed.
Begin filling out your claim form online today to ensure a smooth submission process.
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