Claim Form for MV Wakashio - Organization
Please read carefully the
Communique
and
User Guide
*
are mandatory fields and need to be filled
1. Organization Details
Application Type
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Select application type
New Claim
Update Existing Claim
Previous ID
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Organization Name
*
Registration/
License Number
*
Address of
Organization
*
Activity Type
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2. Organization Representative
Designation
*
Title
*
Select your title
Mr
Mrs
Ms
Surname
*
First Name
*
National ID Card No/
Passport No.
*
Telephone number
Mobile
number
*
Email
3. Claim Details
Type of claim
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Select type of claim
Clean-up operations
Preventive measures
Property damage
Economic loss in the fisheries, mariculture and fish processing sectors
Economic loss in the tourism sector
Costs of measures to prevent pure economic loss
Environmental damage
Post-spill studies
Others
Description of claim
*
4. Bank Details
Bank name
*
Select name of your Bank
ABC Banking Corporation Ltd
Absa Bank (Mauritius) Limited
AfrAsia Bank Limited
Bank of Baroda
BANK OF CHINA (MAURITIUS) LIMITED
Bank One Limited
BanyanTree Bank Limited
BCP Bank (Mauritius) Ltd
Century Banking Corporation Ltd
Habib Bank Limited
HSBC Bank (Mauritius) Limited
Investec Bank (Mauritius) Limited
MauBank Ltd
SBI (Mauritius) Limited
SBM Bank (Mauritius) Ltd
Standard Bank (Mauritius) Limited
Standard Chartered Bank (Mauritius) Limited
The Hongkong and Shanghai Banking Corporation Limited
The Mauritius Commercial Bank Limited
Warwyck Private Bank Ltd
IBAN
SWIFT CODE
Bank Account Number
*
Amount
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5. Declaration
I certify that the information I have given in this form is true, correct and complete.
Please attach all necessary documents for documentary evidence
.
If more than one file, please zip (Max Size: 5 Mb)
Attach
Document
*
Date: