Box 7. Time (A.M. or P.M.). The consumer-plaintiff inserts the time of the accident.
FTCA Claim Form SF-95 Box 8
Box 8. Basis of Claim. The consumer-claimant states in detail the known facts and circumstances attending the damage, injury, or death, identifying persons and property involved, the place of occurrence and the cause thereof.
FTCA Claim Form SF-95 Box 9
Box 9. Name and Address of Owner, If Other Than Claimant. Briefly describe the property, nature and extent of damage and the location where property may be inspected. The consumer-plaintiff inserts the name, street address, city, State and Zip Code of the owner of the damaged property if other than claimant, and describes the property, its location, and the nature and extent of damages.
FTCA Claim Form SF-95 Box 10
Box 10. State Nature and Extent of each Injury or Cause of Death, which forms the Basis of the Claim. If other than Claimant, State Name of Injured Person or Decedent. The consumer-plaintiff describes the nature and extent of each injury and its cause, and the name of the injured or killed person.
FTCA Claim Form SF-95 Box 11
Box 11. Witnesses' Names and Addresses. The consumer lists all of the witnesses to the injuries or deaths and provides their names and addresses.
FTCA Claim Form SF-95 Box 12
Box 12. Amount of Claim 12a. Property Damage. The claimant inserts the dollar amount of damages sought. 12b. Personal Injury. The claimant inserts the dollar amount of damages sought. 12c. Wrongful Death. The claimant or the claimant's representative inserts the dollar amount of damages sought. 12d. Total. The consumer-claimant inserts the dollar amount of the sum of 12a, 12b and 12c. Note that it is important to give a specific dollar amount for each. It is extremely important to know that the amount of damages inserted in the administrative claim form is the maximum amount that can be recovered by the claimant. A claimant will not be able to change the amount of requested damages except under limited circumstances. A(C) Joseph P. Griffith, Jr. 2010
Additional resources provided by the author
For additional resources, see www.joegriffith.com/ftca-claims.html.
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