Form Sws 11 PDF Details

The SWS-11 form, known as the One-Time Loss Sworn Written Statement, emerges as a critical tool within specific legal and financial landscapes, particularly in scenarios involving claims related to the Deepwater Horizon Settlement Program. It serves a dual purpose: firstly, to document the claimant's personal and financial information, and secondly, to provide a structured procedure for detailing the loss incurred from a canceled event, which is directly attributed to the Deepwater Horizon spill. This form meticulously segregates information into distinct sections namely, claimant information, canceling party details, a thorough description of the canceled event including its nature, intended dates, location, the claimant’s relationship to it, as well as an explicit account of the causation directly linking the cancellation to the spill. Furthermore, it addresses the financial implications of the cancelation on the claimant, demanding a precise enumeration of any income lost as a direct result. Notwithstanding, it presses the importance of honesty and accuracy in reporting, underpinning the legal obligation of the claimant to furnish true and complete information under penalty of perjury, including the potential legal consequences for any falsification of the statement or accompanying documents. This elucidation underscores the form’s significance in capturing the economic repercussions of the Deepwater Horizon spill on individual and business events, hence facilitating a structured process for claimants seeking restitution for their financial losses.

QuestionAnswer
Form NameForm Sws 11
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesDeepwater, false, ITIN, written statement template

Form Preview Example

SWS- 11

One Time Loss Sw orn Written Statement

I f you need more space to complete this Sworn Written Statement, attach additional pages and they will be incorporated into this document . Claimant, complete Section A before submitting this Form to the Canceling Party.

A. CLAI MANT I NFORMATI ON

 

Last

First

 

 

 

 

 

 

 

 

 

 

 

 

Middle I nitial

Name:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Deepw ater Horizon Settlement Program Claim Number:

 

 

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Social Security Number:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

or

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I ndividual Taxpayer I dentification Number:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Current Address:

Street

City

State

Zip Code

B. CANCELI NG PARTY I NFORMATI ON

Name:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Street

 

 

 

 

 

 

 

 

 

 

Current

 

 

 

 

 

 

 

 

 

 

 

Address:

City

 

 

State

 

 

 

 

Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Telephone

 

 

 

 

 

 

 

 

 

 

 

Number:

 

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Social Security Number:

or

I ndividual Taxpayer I dentification Number:

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Employer I dentification Number:

SSN or I TI N

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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EI N

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Last

First

Middle I nitial

Authorized Business

Representative Name:

C.CANCELLATI ON OF THE EVENT

1. Description of the Event: I am providing the following information about the canceled Event:

A. The Type or Nature of Event:

B. Date( s) of the Event:

___ / ___ / 2010

C.Location of the Event:

D.Claimant’s Relationship to the Event:

SWS-11

 

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2 . Causation:

I , or my business, canceled the event betw een April 21, 2010 and December 31, 2010 as a result of the Deepw ater Horizon Spill.

3 . Loss to Claimant:

A. The Claimant did lose income as a result of the cancellation of the event .

(1)Amount of contract: $ _____________

(2)Amount of contract to be paid to claimant, if different from the amount in (1): $ _____________

B. The Claimant did not lose income as a result of the cancellation of the event .

D. SI GNATURE

I certify and declare under penalty of perjury pursuant to 28 U.S.C. Section 1746 that all the information I have provided in this Statement (and in any pages I have attached to or submitted with this Statement to provide additional information requested in this Statement) is true and accurate to the best of my knowledge, and that supporting documents attached to or submitted with this Statement and the information contained therein are true, accurate, and complete to the best of my knowledge, and I understand that false statements or claims made in connection with this Statement may result in fines, imprisonment, and/ or any other remedy available by law to the Federal Government, and that suspicious claims will be forwarded to federal, state, and local law enforcement agencies for possible investigation and prosecution.

Date Signed:

_____/ _____/ ______

(Mont h/ Day/ Year)

_________________________________________________

Canceling Party Signature

________________________________________________

Name (Printed or Typed)

SWS-11

 

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How to Edit Form Sws 11 Online for Free

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Step 2: This tool will let you work with PDF forms in various ways. Improve it with personalized text, adjust what is originally in the document, and include a signature - all possible in no time!

Filling out this document will require attentiveness. Make sure that all required areas are filled out properly.

1. Fill out your SSN with a selection of necessary fields. Consider all the necessary information and make sure there's nothing overlooked!

How one can fill in submitting part 1

2. When the last section is complete, you'll want to add the needed details in Social Security Number I ndividual, EI N, Employer I dentification Number, Authorized Business Representative, Last, First, Middle I nitial, Description of the Event I am, C CANCELLATI ON OF THE EVENT, A The Type or Nature of Event, B Date s of the Event, C Location of the Event, D Claimants Relationship to, the Event, and SWS v so you can progress further.

Step no. 2 of filling in submitting

Always be extremely careful when filling in SWS v and C CANCELLATI ON OF THE EVENT, as this is the section where most users make errors.

3. The following segment will be about Causation, I or my business canceled the, of the Deepw ater Horizon Spill, Loss to Claimant, The Claimant did lose income as a, Amount of contract, Amount of contract to be paid to, The Claimant did not lose income, D SI GNATURE, and I certify and declare under - complete all these fields.

Stage number 3 of completing submitting

4. Completing Date Signed, Month Day Year, Canceling Party Signature, and Name Printed or Typed is crucial in this fourth step - be certain to be patient and be mindful with each blank area!

How one can fill in submitting portion 4

Step 3: Spell-check the information you have inserted in the blank fields and then click the "Done" button. Get hold of your SSN once you join for a 7-day free trial. Immediately access the pdf form within your personal cabinet, along with any modifications and changes automatically synced! FormsPal guarantees your information privacy by having a secure method that in no way saves or distributes any kind of private data used. Be confident knowing your documents are kept protected whenever you use our tools!

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