Claimant Request For Change Of Address - Deepwater Horizon Settlement Program
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2Claimant Request for Change of Address
A. Claimant Information
Last Name or Full Name of Business
First Name
Middle Initial
Name:
Deepwater Horizon Settlement Program Claimant Number:
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Social Security Number:
SSN or ITIN
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Individual Taxpayer Identification Number:
or
EIN
Employer Identification Number:
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_____/_____/______
Date of Birth:
(Month/Day/Year)
B. Change of Address
You must complete this form and provide proof of change of address in order for the Deepwater Horizon Settlement Program
to process your change of address request.
Street
Address on File with
City
State
Zip Code
DWH:
Street
City
State
Zip Code
New Address:
Email
Home
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Home/Cell Phone
Number:
Cell
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C. Provided Proof of New Address
You must provide proof of your new address. Please indicate below the proof being provided and attach that proof to this
form.
Drivers’ License with your new address
Government Issued I.D. with your new address
Utility or credit card bill with your new address
A property tax bill, statement, or receipt with your new address
Any letter or correspondence (including tax bills) received from the IRS or state tax office with your new address
Deed, mortgage, lease or rental agreement with your new address and your name listed as the homeowner, lessee or
renter
First-class mail from any government agency with your new address
Checking or savings account statement with your new address
Vehicle Registration Card with your new address
W-2 Form or 1099 form with your new address
Check here if you do not have any of the foregoing types of proof of address and describe the proof being
provided
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