Get Auxiliary Facility Loss Or Damage Claim Worksheet 1998-2026

Filling out the Auxiliary Facility Loss or Damage Claim Worksheet can be a straightforward process if you follow the provided steps carefully. This guide is designed to help you navigate each section of the form online efficiently.

Follow the steps to successfully complete your claim worksheet.

1. Click ‘Get Form’ button to access the worksheet and open it in your preferred online editor.
2. Begin by entering your personal details in the Claimant and Facility Information section. Include your name, Social Security Number, address, telephone number, and facility name. Make sure to indicate if you are currently enrolled in direct deposit.
3. In the Time and Place of Loss section, provide the date, time, and location of the incident. Include details such as patrol area, course, speed, and the approximate time since the last course change.
4. Fill out the Weather Conditions section by selecting the appropriate options that describe the situation at the time of the loss or damage. Record any relevant details about the sea conditions and visibility.
5. In the Damage to Auxiliary Facility section, indicate the type of loss or damage. Describe the incident in detail, including actions taken by crew members and any repairs made.
6. If there were damages to other facilities or property, complete this section with necessary details about other affected parties and specify the nature of the damages.
7. List witnesses in the Witnesses section, including crew members present during the incident. Fill in their names, addresses, and auxiliary member numbers if applicable.
8. Provide information regarding insurance, including the company's name, policy number, and whether you have filed a claim with your insurer.
9. Fill out the Inspection of Damage section, noting any inspections conducted by the Coast Guard and their findings.
10. In the Substantiation of Claim section, record the amount claimed and attach all necessary estimates for repair costs along with other relevant documents.
11. Review your information for accuracy before finalizing. Once completed, you can save changes, download the form, print it for submission, or share it as needed.

Complete your Auxiliary Facility Loss or Damage Claim Worksheet online today to ensure a timely and effective claims process.