Get Sws-12

The SWS-12, or Individual Economic Loss Employer Sworn Written Statement, is a crucial document for employers responding to claims related to economic losses. This guide will provide clear instructions to help you complete the form accurately and efficiently.

Follow the steps to complete the SWS-12 form online

1. Press the ‘Get Form’ button to access the SWS-12 document and open it for editing.
2. In Section A, the claimant needs to fill out their personal information including name, claimant number, social security number or individual taxpayer identification number, and current address.
3. In Section B, employers must provide their business name, address, phone number, website, and the claimant's employment details such as start and end date and identification numbers.
4. For Section C, if applicable, indicate the reason for termination. Select one of the three options provided and specify details if the termination was for another reason.
5. Complete Section D if you made an offer of employment to the claimant and later withdrew or changed that offer; provide dates and wage rate details.
6. In Section E, explain how the claimant’s economic losses from the Spill relate to their economic situation during the specified period.
7. For Section F, indicate the non-hourly wage employee's position, dates of employment, hours worked, and salary. Provide documentation of hours worked if available.
8. In Section G, confirm if your business provided significant services to the Oil and Gas Industry in 2009 and list the types of work the claimant was engaged in.
9. Finally, in Section H, certify the form by signing it, including the date, and print or type your name as an employer representative before submission.
10. After completing all sections, save the changes, download, print, or share the form as necessary.

Complete your SWS-12 form online today for timely processing of economic loss claims.