Vessels of Opportunity Charter Payment

SWS-45
v.1
Vessels of Opportunity Charter Payment
Sworn Written Statement for Vessel Owner Release of Claim
SWS-45
The policies and procedures set forth by the Claims Administrator of the Deepwater Horizon Settlement Program (“Program”)
require that the Program may only find one VoO Charter Payment claim eligible per vessel. If more than one individual
signed a Master Vessel Charter Agreement (“MVCA”) for one vessel, or two individuals signed different MVCAs for the same
vessel, the Program considers the vessel owner presumptively eligible over a lessee or vessel operator. A claimant who is not
the vessel owner may submit this SWS-45 to rebut this presumption. The vessel owner must sign this Form. The claimant
may not sign the Form and a lawyer may not sign on the vessel owner or claimant’s behalf.
A. CLAIMANT INFORMATION
Last
Name:
First
Middle Initial
Name of Business
Deepwater Horizon Settlement Program Claimant Number:
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Street
Address:
City
State
Telephone Number:
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SSN or ITIN
Social Security Number:
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EIN
Individual Taxpayer Identification Number:
Employer Identification Number:
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Zip Code
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B. VESSEL OWNER INFORMATION
Last
Name:
First
Middle Initial
Name of Business
Street
Address:
City
State
Telephone Number:
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Zip Code
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C. VESSEL INFORMATION
Vessel Name:
Hull Identification Number:
Year:
Federal Registration Number:
State Registration
Number:
Make:
Model:
1
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SWS-45
v.1
D. OWNERSHIP ACKNOWLEDGMENT AND CLAIM RELEASE STATEMENTS
You must check all of the boxes in this Section.
I owned this vessel during the VoO program and either signed an MVCA in conjunction with the claimant or allowed the claimant to
operate or lease the vessel to work in the VoO program under a different MVCA.
I understand that the claimant is submitting a claim to the Deepwater Horizon Settlement Program on behalf of the vessel and that the
Program may only find one VoO Charter Payment claim eligible per vessel.
I permit the claimant to submit this VoO Charter Payment claim on behalf of the vessel and understand that if the Deepwater Horizon
Settlement Program finds the submitted claim for the vessel to be eligible, any future claims I submit on behalf of the vessel will not be
found eligible as a result. As such, I waive my right to submit a claim to the Deepwater Horizon Settlement Program for the vessel
listed in Section C of this Form.
E. SIGNATURE
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:
_____/_____/______
(Month/Day/Year)
_________________________________________________
Vessel Owner Signature
Last
First
Middle Initial
Name: (Printed or Typed)
Title (if business
representative):
F. HOW TO SUBMIT THIS FORM
The claimant may submit this form online using the claimant’s DWH Portal. If you are unable to access the DWH Portal, you
may submit this form in any of the following ways:
Deepwater Horizon Economic Claims Center
By Mail
(Postmarked no later than your Response deadline)
PO Box 1439
Hammond, LA 70404-1439
Deepwater Horizon Economic Claims Center
c/o Claims Administrator
By Overnight, Certified or Registered Mail
(Postmarked no later than your Response deadline)
42548 Happy Woods Road
Hammond, LA 70403
By Facsimile
(Sent no later than 12:00 midnight local time on your
Response deadline)
(888) 524-1583
By Email
(Sent no later than 12:00 midnight local time on your
Response deadline)
[email protected]
Visit a Claimant Assistance Center
(Delivered no later than your Response deadline)
You may take the required information or documents to a
Claimant Assistance Center.
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