Subsistence Form – Fill Out and Use This PDF

DEEPWATER HORIZON ECONOMIC AND PROPERTY SETTLEMENT

SUBSISTENCE CLAIM FORM

(TEAL FORM)

To make a Subsistence Claim under the Deepwater Horizon Economic and Property Damages Settlement Agreement (the “Settlement”) for damages arising from the Deepwater Horizon Incident on April 20, 2010, (the “Spill”), you must complete and submit this Claim Form and all documentation required by the Settlement (“Supporting Documentation”) to the Claims

Administrator on or before six months after the Effective Date. The Effective Date is when the approval of the Settlement Agreement becomes legally final, after all appeals of the District Court’s Final Approval Order have been concluded by

appellate courts or the date otherwise agreed upon by BP and Class Counsel. We do not yet know the Effective Date. You should check the Settlement Program website frequently for updates on this important deadline.

The Subsistence Claim is for Gulf Coast individuals who fish or hunt to harvest, catch, barter, consume, or trade Gulf of Mexico natural resources (including seafood and game) in a traditional or customary manner, to sustain their basic personal or family dietary, economic, security, shelter, tool, or clothing needs, and who prove that they sustained a loss of subsistence use of natural resources because of the Spill. Recreational Fishermen and Recreational Hunters – those who fish or hunt for pleasure or sport – are not eligible to make Subsistence Claims, regardless of whether they consume, barter, or trade their catch. The Subsistence Claimant definition does include claimants who hold a Recreational Fishing license, provided such claimants satisfy the other elements of the Subsistence Claimant definition and provide the required documentation.

When completing this Claim Form, refer to the accompanying booklet called “Instructions for Completing the Subsistence

Claim Form (Teal Form),” which contains detailed instructions for completing and submitting this Claim Form, helpful definitions, and the list of Supporting Documentation required to prove your claim.

If you have access to a computer with an internet connection, it will be far easier for you to fill out and submit your Claim Form online, rather than on this paper Claim Form. The online claim process will guide you through only the specific questions you need to answer, and will instruct you about the specific Supporting Documentation you must submit, based on the answers you enter as you go along. Go to www.deepwaterhorizonsettlements.com to submit a claim online.

If you do not have access to the internet, you may visit a Claimant Assistance Center for assistance with submitting a claim in person. Section 6 of the Subsistence Instructions Booklet lists all the Claimant Assistance Centers.

A. Claimant Information

Provide the following information about the Natural Person who is making this Subsistence Claim.

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10.Provide a specific description of where you hunted and/or fished for each species in the Gulf of Mexico before the Spill. In addition to the written description below, also provide a map that identifies where you hunted and/or fished each species in the Gulf of Mexico before the Spill.

11.Out of the total quantity of Game and/or Seafood you and your family relied on before the Spill, approximately what percentage by species and location came from areas that were later closed, impaired, or harmed because of the Spill?

12. Describe the equipment and methods you use to hunt and/or fish for subsistence use.

If you checked “Yes,” for Question 13, provide a specific description of where and what species you fished and/or hunted for subsistence purposes between April 20, 2010 and December 31, 2011, and what quantity of Game and/or Seafood you were able to catch over that period.

TO FILE YOUR CLAIM ONLINE VISIT WWW.DEEPWATERHORIZONSETTLEMENTS.COM

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C. Documentation Required for a Subsistence Claim

In addition to this Claim Form, you must submit certain Supporting Documentation to prove your Subsistence Claim. The list of required documents, and instructions for how to submit them, are in Section 4 of the Subsistence Instructions Booklet. If you do not submit the required Supporting Documentation, the Claims Administrator will not be able to review your claim and you will not receive payment for your claim.

D. Payment

1.If You Have Your Own Attorney. Unless you check the box below, the Claims Administrator will make any payments jointly to you and to your attorney, which means that both you and your attorney will need to endorse the check before a bank will honor it.

Check here if you want the Claims Administrator to make payments in connection with this and any other claim you may file in the Deepwater Horizon Economic and Property Settlement only to your attorney. This means that the Claims Administrator will send your payment to your attorney, who will then pay you pursuant to the retainer agreement you have with him/her.

2.If You Do Not Have Your Own Attorney. If you have not retained an attorney to represent you in connection with your Spill-related claim, the Claims Administrator will make any payments to which you are entitled directly to you by check. Payment checks will be sent by First Class Mail to the address you provided in the Registration Form or to the address that the Claims Administrator confirms for you during the processing of your Claim. You have an obligation to notify the Claims Administrator if your address changes.

The Claims Administrator will report annually to federal and state taxing authorities, using a Form 1099 or state form equivalent, for certain payments made. The Claims Administrator will send you a copy of that form, but cannot give you any tax advice regarding any payment issued to you. You should consult with your own tax advisor to determine the tax impact of any payment you receive from the Claims Administrator.

3.Garnishments, Liens and other Attachments. Legally authorized garnishments, liens, or similar forms of attachments relating to your claim will be honored and deducted from your payment.

4.W-9 Form Requirement. All claimants must provide a W-9 Form. To obtain a copy of that form, go to www.deepwaterhorizonsettlements.com, or request one at a Claimant Assistance Center or by calling 1-866-992-6174.

E. Signature

I certify and declare under penalty of perjury pursuant to 28 U.S.C. Section 1746 that the information provided in this Claim Form is true and accurate to the best of my knowledge, and that supporting documents attached to or submitted in connection with this form 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 Claim Form 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.

By submitting this Claim Form, I consent to the use and disclosure by the Claims Administrator and those assisting the Claims Administrator of any information about me that they believe necessary and/or helpful to process my claim for compensation and any payment resulting from that claim.

The claimant must sign this Claim Form personally. No one can sign on behalf of the claimant unless the claimant is deceased, a Minor, or Incompetent. If the claimant is deceased, a Minor, or Incompetent, an authorized Representative may sign.

TO FILE YOUR CLAIM ONLINE VISIT WWW.DEEPWATERHORIZONSETTLEMENTS.COM

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