Get Claim Form - City Of Norwalk

Filling out the Claim Form for the City of Norwalk online can be straightforward if you understand each section of the form. This guide provides step-by-step instructions to ensure you complete the form accurately and effectively.

Follow the steps to fill out the Claim Form online.

1. Press the 'Get Form' button to access the Claim Form and open it in your preferred editor.
2. Enter today's date in the designated field at the top of the form. This indicates when you are filing your claim.
3. Fill in the name of the claimant in the corresponding section. Ensure you enter the full name of the person making the claim.
4. Provide the occupation of the claimant. This information helps clarify the claimant's professional background.
5. Complete the home address section. Include street address, city, state, and ZIP code to ensure proper communication.
6. List the home phone number, as well as a mailing address if it differs from the home address. This ensures you receive all necessary notifications regarding the claim.
7. Fill in the cell phone and email address fields to facilitate quick communication related to the claim.
8. Specify the date and time when the damage or injury occurred. Be as precise as possible to assist in the investigation of your claim.
9. Identify any City of Norwalk employees involved in the incident, if applicable, to support your claim.
10. Describe the exact location of the damage or injury, including any relevant street names or landmark measurements to provide clarity.
11. In detail, explain how the damage or injury occurred. This narrative should provide a comprehensive view of the circumstances.
12. Articulate why you believe the City of Norwalk is responsible for the damage or injury, detailing any factual basis for this assertion.
13. Describe each injury or damage in detail to quantify your claim accurately.
14. Use the following fields to compute the total amount claimed, providing exact figures for damages incurred, estimated future damages, and total damages.
15. Indicate whether police investigated the incident and record any relevant details, including sworn statements from paramedics or ambulance services, if applicable.
16. List all witnesses with their names, addresses, and phone numbers who may provide information regarding the incident.
17. Include the names and contact details of doctors and hospitals related to the injury treatment, which will support your claim.
18. If necessary, complete the diagram on page 2 by marking streets, the exact location of the accident, and any involved city vehicles.
19. Sign the form at the designated area to confirm the accuracy of your claim, and ensure to date the signature.
20. Finally, save your changes, and consider downloading, printing, or sharing the completed Claim Form as applicable.

Begin the process of filing your claim online today.