Get Claim Form - City Of Seal Beach - Sealbeachca

Filing a claim with the City of Seal Beach can be a straightforward process if you follow the necessary steps. This guide provides detailed instructions to help you fill out the Claim Form accurately and efficiently, ensuring that your claim is processed without delays.

Follow the steps to complete the Claim Form successfully.

1. Press the ‘Get Form’ button to access the Claim Form and open it for completion.
2. In the first section, enter the claimant's name and date of birth. Ensure this information is accurate as it identifies the person making the claim.
3. Provide a daytime phone number where you can be reached, followed by your mailing address, including street number, street, city, state, and zip code.
4. Input your social security number and your home phone number, ensuring that this information remains confidential.
5. Detail the date and time of the loss you are claiming.
6. Clearly describe the location of the loss, providing as much detail as possible.
7. In this section, write a thorough description of the incident or accident that led you to file the claim.
8. List the specific injuries, damages, or other losses you incurred as a result of the incident.
9. Explain your basis for claiming that the City or any City employee(s) are responsible for your injury, damages, or loss.
10. Indicate the amount of money you are seeking to recover by checking the appropriate box and entering the specific amount if it is less than $10,000.
11. Describe how you calculated the amount claimed, attaching any bills, repair estimates, and receipts that support your claim.
12. If known, provide the names of any City employee(s) who are alleged to have caused your injury, damages, or loss.
13. Enter the names, addresses, and phone numbers of any witnesses who can support your claim.
14. Provide any additional information that may assist in the consideration of your claim.
15. Complete the section for directing notices and communications to a different individual if applicable, providing their name, relationship, address, state, daytime phone, and home phone.
16. Finally, sign and date the form. If someone is filing on behalf of the claimant, they should also sign.
17. Review all entries for accuracy. Save changes, download, print, or share the completed form as necessary.

Start completing your Claim Form online today to ensure a timely response to your request.