Get Form 95

This guide provides step-by-step instructions for completing Form 95 online, a claim form for damage, injury, or death under the Federal Tort Claims Act. By following these instructions, you will ensure that all necessary information is accurately provided to support your claim.

Follow the steps to complete Form 95 successfully.

1. Press the ‘Get Form’ button to access the form and open it in your online editor.
2. In the first section, submit the claim to the appropriate federal agency by clearly indicating the agency's name.
3. Provide the name and address of the claimant, including any personal representative, using the specified format: number, street, city, state, and zip code.
4. Select the type of employment by marking either 'military' or 'civilian' as applicable.
5. Enter the date of birth of the claimant.
6. Indicate the marital status of the claimant by marking the appropriate box.
7. Fill in the date and day of the accident.
8. Provide the time of the accident, indicating whether it was A.M. or P.M.
9. Detail the basis of the claim by explaining the known facts and circumstances related to the damage, injury, or death.
10. If property damage is involved, list the owner's name and address if they are different from the claimant.
11. Describe the property, the nature and extent of damage, and the location where the property can be inspected.
12. For personal injury or wrongful death claims, state the nature and extent of each injury or cause of death relevant to the claim.
13. List any witnesses by providing their names and addresses.
14. Indicate the amount of claim for property damage, personal injury, and wrongful death, ensuring that the total is calculated correctly.
15. The claimant must certify that the claim covers all damages caused by the incident and agree to accept the stated amount in full satisfaction of the claim.
16. Include the signature of the claimant, their phone number, and the date of signature.
17. Finally, review all entries for accuracy before saving, downloading, printing, or sharing the completed form.

Complete your Form 95 online today to ensure your claim is filed accurately and efficiently.