U.S. Armed Forces Claims Service-Korea. Military Claims Division

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1 FLOOD DAMAGE OR LOSS U.S. Armed Forces Claims Service-Korea Military Claims Division

2 DEPARTMENT OF THE ARMY UNITED STATES ARMED FORCES CLAIMS SERVICE-KOREA UNIT #15311 APO AP FKJA-CSK 9 November 2015 MEMORANDUM FOR CLAIMANTS SUBJECT: Procedures for Filing Personnel Claims 1. Welcome to the Military Claims Division, U.S. Armed Forces Claims Service-Korea. Enclosed are instructions and forms on how to file a claim for loss of, damage to, or destruction of, your personal property. 2. It is unfortunate that you have incurred a loss, or suffered damage or destruction, of your personal property. The goal of our Military Claims Division is to investigate and fairly settle your claim as quickly as possible, within the limits imposed by Congress and the Department of the Army. In order to process your claim in a timely manner, it is important that you read and carefully follow the enclosed instructions, that you carefully complete all applicable claims forms, and that you submit documentation to substantiate your claim. 3. A claims survey form is attached to this letter. We are genuinely interested in your comments regarding our service to you and welcome any suggestions for improvements. Please return this form at the time you file your claim or fold it in half and mail it postagefree through the MPS. 4. The Military Claims Division is open on a walk-in basis: & , Monday, Tuesday, Wednesday & Friday , Thursday 5. If you need assistance at any stage in the claims process, please do not hesitate to contact us at DSN /8108 or COM /8108. Encls as LESLIE J. FEIST Supervisory Paralegal Specialist U.S. Armed Forces Claims Service-Korea

3 FLOOD CLAIM CHECKLIST The following is required to process a claim for flood loss or damage: Claim Documents: Original Signed DD Form 1842 (sample form & blank form enclosed). Home Address (block 5) enter your mailing address for receiving correspondence Military Address (block 6) enter your unit/organization address DD Form 1844 (sample form & blank form enclosed). Complete blocks 1 13 (if not applicable, write NA ) Original cost, year & month purchased must be listed Either repair cost or replacement cost must be listed (NOT BOTH) Each item claimed must be a separate line item Estimate fee(s) must also be listed as separate line item(s) Statement of Understanding Regarding Private Insurance (enclosed). Documentary Evidence to Substantiate Flood Damage. Military Police Report, or memorandum from your Unit Commander/First Sergeant/Directorate substantiating flood damage. Original Signed Statement Regarding Working Condition of Electronic Item Prior to Flood (enclosed). If any items you are claiming are electronic items, you must provide a statement specifically stating the working condition of the item prior to the flood, and specifying how you knew it was working. A general statement stating it worked before the flood is not sufficient. You must complete a separate statement for each item. Photographs. You must provide photographs of your damaged or destroyed items. Photographs must include a view of the entire object, as well as close-ups of the damage. Photographs must be of good quality, and not grainy in nature. Photographs will be taken by claims personnel (if necessary). Purchase Receipts. You must provide copies of a purchase receipt, credit card statement, cancelled check, appraisal, or some other form of substantiation to prove purchase date, cost, and ownership, of items of a value of $100 or greater (if your total claim exceeds $500). Vehicle Registration & Insurance (for vehicle damage). Original Signed Electronic Item Repair Form (enclosed). If electronic items were damaged, you must obtain an electronic repair estimate from a reputable repair firm. Written Repair Estimates. ALL property that is damaged, having a value of $ or more, must have an itemized repair estimate from a reputable repair firm. The estimate of repair must specifically detail the specific damage(s) being repaired and cost, or specify that the item is not repairable. NOTE: If already repaired, a detailed written repair bill specifying the damage(s) repaired must be submitted. Replacement Costs. Replacement costs must be substantiated for items determined not repairable by a reputable repair firm. You may submit documentary evidence of replacement costs from the PX, catalogs, or the Internet.

4 Other Administrative Documents: Orders and all Amendments. You must provide a copy of your assignment orders to Korea all amendments. Original Manual CEFT Input Information worksheet (blank form enclosed). Any payment will be made by direct deposit into your bank account. Fill out this form completely. Ensure that the correct routing and account number is on the form, as incorrect information will prevent payment. Insurance Settlement (if private insurance paid any funds associated with damage). If you have private insurance, you MUST file with your claim through your private insurance. Power of Attorney (POA) You must have a POA if you are filing for your sponsor, spouse, or someone else. NOTE: Additional documentation or information may be required in the course of adjudicating your claim. Failure to provide necessary documentation will result in action based available information. ADDITIONAL CLAIM INFORMATION You have up to two years from the date of incident to file a claim with a Military Claims Office. Do not dispose of any claimed property until advised to do so by the Claims Office. If this is done, it may result in a deduction from your claim payment. If an item is not economically repairable, but still useful for its intended purpose and you wish to keep it, you may claim a reasonable amount for its Loss of Value and retain that item. If you desire copies of any forms or documents pertaining to your claim, you should make these copies prior to coming to the Claims Office. You must turn in all original documents to the Claims Office. If you need assistance, feel free to come by our office during normal office hours or call to speak to one of our representatives.

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13 STATEMENT OF UNDERSTANDING Paragraphs 11-10f and 11-21b (5) of AR 27-20, provide that no claim may be paid under this chapter if there is private insurance that may cover the loss. Therefore, if you have any insurance, which may cover all or any parts of this loss, you must first settle with your insurer. Your claim against the Army must include a copy of your insurance settlement. Insurance coverage includes: comprehensive automobile, automobile theft, homeowners renters, and personal effects floater policies. If you have none of these types of insurance in effect either now, or at the time of loss/damage being claimed, please read the statement below and sign. I READ AND UNDERSTAND THE ABOVE REQUIREMENTS. I HAVE INDICATED ON MY CLAIM AGAINST THE UNITED STATES (DD FORM 1842) THAT I DO NOT HAVE ANY PRIVATE INSURANCE WHICH MAY COVER ALL OR ANY OF THE LOSS OR DAMAGE ON MY CLAIM AGAINST THE UNITED STATES, IF I BECOME AWARE AT ANY TIME THAT I HAD INSURANCE THAT COVERED SUCH LOSS OR DAMAGE, I WILL SO NOTIFY THE CLAIMS OFFICE. SIGNATURE OF CLAIMANT DATE

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15 Statement Regarding Working Condition of Electronic Item Prior to Flood Item Description: STATEMENT: DATE SIGNATURE PRINTED NAME

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17 REPAIR FORM FOR ELECTRONIC ITEMS Attached is an electronic repair form. You will need one of these forms filled out for each electronic item you wish to claim. The form must be completed by a qualified employee of a reputable repair firm. If the estimate you obtain is unreasonable, you will be asked to obtain another one. Please read the rest of this memo carefully. If you do not follow the instructions below, you will not be reimbursed for damage to your electronic item. Computers require a special form. EXTERNAL DAMAGE If there is external damage to your electronic item, make sure the repair person notes the external damage and gives a detailed description of the location, nature, and extent of the damage on the electronic repair form. This is your responsibility. If you present an estimate without the proper explanation of external damage, you will be asked to return to the shop and have the estimate properly completed or you will not receive any money for that particular electronic item. INTERNAL DAMAGE ONLY Often an electronic item will be delivered with internal damage but no external damage. Without proof of the mechanical condition prior to the move, there is no evidence the item was functional and the carrier can deny liability for the damage. You must provide a statement providing evidence the item worked prior to the move. This should include the last time the item was used (e.g., my family watched a video the night before we moved the VCR worked fine ). Also, include any statements that might explain the internal damage to the item (e.g., saw the mover drop the box with my stereo in it ). Statements by other people who used the item shortly before the move or saw the item being used may also be helpful. There is no prescribed format for this statement. In fact, you may write your statement in the space provided below. It must be a detailed and truthful statement in your own words or by another person with knowledge of the events or circumstances described. Please sign and date the statement. If you fail to provide a statement as explained above, the portion of your claim relating to that item will be disallowed.

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19 ELECTRONIC REPAIR FORM 전자제품견적서 (not to be used for CPUs & Laptops ) 컴퓨터, 노트북, CPUs 에는사용하지마세요 ITEM DESCRIPTION 품목설명 CLAIMANT S NAME 청구인이름 : DATE ITEM EXAMINED 검사일 : TYPE OF ITEM 품목의종류 : MANUFACTURER 제조업체 : MODEL 모델 : SERIAL NUMBER 고유번호 : EXTERAL DAMAGE 외부손상 IS THERE EXTERNAL DAMAGE? 외부손상이있습니까? [ ] YES 예 [ ] NO 아니오 DESCRIPTION AND LOCATION OF ANY EXTERNAL DAMAGE 외부손상의위치및정도를설명해주세요 : THE EXTERNAL DAMAGE APPEARS TO BE 외부손상은언제생겼다고보여집니까 : [ ] NEW 새로 [ ] OLD 오래전에 [ ] BOTH NEW & OLD 새로 & 오래전에 [ ] CANNOT DETERMINE 구분할수 없음 THE NEW EXTERNAL DAMAGE APPEARS TO HAVE BEEN CAUSED BY SHIPPING 새로생긴외부손상이선적중에발생되었다고생각합니까 : [ ] DEFINITELY 확실히 [ ] PROBABLY 상당히 [ ] POSSIBLY 아마도 [ ] NO 아니다 [ ] CANNOT DETERMINE 구분할수없다 IF NEW EXTERNAL DAMAGE IS NOT CAUSED BY SHIPPING, WHAT MAY HAVE CAUSED IT 새로운외부손상이선적중에생긴것이아니라면 손상원인이무엇이라고생각합니까 : INTERNAL DAMAGE 내부손상 IS THERE INTERNAL DAMAGE? 내부손상이있습니까? [ ] YES 네 [ ] NO 아니오 DESCRIPTION AND LOCATION OF ANY INTERNAL DAMAGE 내부손상의위치및정도를설명해주세요 : THE INTERNAL DAMAGE APPEARS TO BE 내부손상은언제생겼다고보여집니까 : [ ] NEW 새로 [ ] OLD 오래전에 [ ] BOTH NEW & OLD 새로 & 오래전에 [ ] CANNOT DETERMINE 구분할수 없음 THE NEW INTERNAL DAMAGE APPEARS TO HAVE BEEN CAUSED BY SHIPPING 새로운내부손상이선적중에발생되었다고생각합니까 : [ ] DEFINITELY 확실히 [ ] PROBABLY 상당히 [ ] POSSIBLY 아마도 [ ] NO 아니다 [ ] CANNOT DETERMINE 구분할수없다 IF INTERNAL DAMAGE IS NOT CAUSED BY SHIPPING, WHAT MAY HAVE CAUSED IT 새로운내부손상이선적중에생긴것이아니라면 손상원인이무엇이라고생각합니까 : UNREPAIRABLE ITEM IF UNREPAIRABLE, EXPLAIN WHY THE ITEM CANNOT BE REPAIRED 수리가불가능하다면, 그이유를적어주세요 : WAS AN ESTIMATE FEE PAID? 견적서발급비용이청구되었습니까? [ ] NO 아니오 [ ] YES 네 (AMOUNT 가격 ) DOES THE ITEM HAVE SALVAGE VALUE? 잔존가치 ( 처분하였을때취득할수있는가격 ) 가있습니까? [ ] NO 아니오 [ ] YES 네 (AMOUNT 가격 ) CONTINUE ON REVERSE SIDE

20 REPAIR COST INFORMATION 수리비용정보 THE PARTS AND COSTS INVOLVED ARE LISTED BELOW 수리가능시필요한부품과공임시간및비용을적어주세요 : CHECK FOR EACH PART REPAIR PART 수리부품 COST 가격 해당사항에체크해주세요 SHIPPING DAMAGE 선적중발생한파손 NON-SHIPPING DAMAGE 그외발생한파손 LABOR 공임 OTHER SERVICES (SPECIFY) 기타서비스 ESTIMATE FEE* 견적서비용 TOTAL 합계 * WILL THE ESTIMATE FEE BE DEDUCTED FROM THE TOTAL BILL ONCE THE REPAIRS ARE MADE? 수리가능한물품에대한견적서비용은수리시총비용에포함됩니까? [ ] YES 네 [ ] NO 아니오 * ESTIMATE FEE LISTED IS FOR THIS ITEM ONLY, OR FOR ALL ITEMS INSPECTED DURING THIS VISIT 견적서비용은위품목하나에만적용됩니까검사한모든품목에적용됩니까 : [ ] THIS ITEM ONLY 하나의품목 [ ] ALL ITEMS 모든품목 REPAIR COMPANY INFORMATION 회사정보 BY COMPLETING THIS FORM, I CERTIFY THAT I HAVE PERSONALLY INSPECTED THE ABOVE LISTED ITEM, THE INFORMATION ANNOTATED ON THIS FORM IS TRUE AND CORRECT, AND THAT THIS COMPANY IS QUALIFIED TO MAKE ANY NECESSARY REPAIRS ANNOTATED. 저는모든품목에대한검사를직접하였으며, 서식에적은모든내용은거짓없으며정확합니다. 우리회사는위서식에기술된수리를 수행할수있는검증된곳입니다. REPAIR COMPANY NAME 수리회사명 REPAIR COMPANY ADDRESS 수리회사주소 PHONE NUMBER 전화번호 EXAMINER S NAME 검사자이름 SIGNATURE 사인

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25 ELECTRONIC FUNDS TRANSFER Payment Via Electronic Funds Transfer The contractor shall receive all payments against this order via EFT, bank-to-bank transfer. The transfer amount shall be in the local foreign currency in the amount specified within this purchase order. Any bank processing fees, taxes, or other surcharges are the responsibility of the contractor and are not subject to reimbursement (unless already incorporated into the subject order/contract in the total shown on page 1, block 26 of this purchase order/contract.) Before payment via EFT may be processed, the contractor is required to submit a verified invoice (per ) and a completed EFT information form (provided below). ELECTRONIC FUND TRANSFER INFORMATION (VENDOR PAY) Recipient Name: (Must be exact name on account) Social Security No. / KID No.: Recipient Address: Account Type: (Checking, IBAN,etc) *Account must be in same currency contract is written in. Account Number: Banking Routing Number (or SWIFT code): Bank Name: Bank Address: Recipient Name: Signature: Date: Representative Name (optional) Signature: Date: (See Reverse Side)

26 PRIVACY ACT STATEMENT AUTHORITY: 31 U.S.C. 3721, and EO 9397, November 1943 (SSN). PRINCIPAL PURPOSE(S): Filing, investigation, processing and settlement of claims for losses incident to service. ROUTINE USES: a. Information is principally used to provide a legal basis for the administrative payment of claims against the Government. Information is also used in connection with: (1) Recovery from common carriers, warehouse firms, insurers and other third parties. (2) Collection from claimants of improper payments or overpayments. (3) Investigation of possible fraudulent claims. (4) Possible criminal prosecution by the Department of Justice or other agencies if fraud is established. b. Social Security Numbers are used to assure correct identification of claimants in order to assure payment to the proper claimant and avoid duplication of claims. DISCLOSURE: Voluntary; however, failure to supply information will cause delay in settlement and may result in denial of a portion or all of the claim NOTE: Miscellaneous payments, such as legal claims, which must go through GFEBS have a limitation on bank account information. Sometimes, employees or military members may want to choose an alternate bank account for their miscellaneous payment. Under GFEBS, this is not possible. The system is designed to validate bank information with the account the individual uses for their payroll deposit. If the two do not match, the system will not allow the payment to process.

27 PARTIAL LISTING OF REPAIR SHOPS The Military Claims Division has prepared this as a service to Area II personnel. It is intended as a partial listing only. Listing of a firm does not constitute an endorsement of its products or services by the U.S. Government or the Military Claims Division. Exclusion of a firm from this list does not imply that such a firm is unreliable or should not be used. All phone numbers listed are off-post Korean civilian numbers unless otherwise noted. If you find any errors in the listings below or if you are aware of any additional firms performing any of the services listed, please let our office know. AUTOMOTIVE REPAIR AUTO Craft Shop DSN: / 5042 Dunlop Body/Repair COM: Youngjin Auto Glass (Windshield/Glass only) COM: / COMPUTERS/TYPEWRITERS/ OFFICE MACHINE Chin Han Repair Shop COM: CELL: Jonny Computer COM: Computer repair shop in Gallery DSN: Bldg # 2209 FUR/LEATHER/SUEDE Mimi Dry-cleaning COM: / FURNITURE REPAIR REFRIGERATOR/AIR CONDITIONER AAFES Concession Repair DSN: TV/RADIO/STEREO/CAMCORDER REPAIR AAFES Electronic Repair Shop TEL: DSN VARIOUS ITEMS Green Repair Shop COM: CELL: MOLD ISSUES UN Express COM: CELL: Renew Engineering COM: CKMC COM: CELL: Chin Han Repair Shop COM: CELL: GRANDFATHER CLOCKS Chin Han Repair Shop COM: CELL: MUSICAL INSTRUMENTS Chin Han Repair Shop COM: CELL: Yamaha Piano Service Center COM:

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29 CLAIMS SURVEY Please answer the questions below and furnish comments to assist us in providing better service to our customers. After completing the survey, place it in either the survey box located in the Client Legal Services Division or fold it in half and mail it postage free through the Military Postal System. 1. What was the name of the person who assisted you during your visit to our office? 2. Is there anything you would like this person to have done differently? 3. How would you rate the service you were provided during your visit (Check One) Excellent Good Fair Poor 4. Did the instructions in the claims packet adequately explain how to prepare your claim forms? Yes No If not, what was it that was unclear to you? How could it be improved? 5. Were you given a satisfactory explanation concerning the methods the Claims Office used to compute your claim settlement? Yes No If not, what other information should we have provided? OPTIONAL: Your Name Work Number Date

30 MPS U.S. Armed Forces Claims Service-Korea ATTN: Deputy Chief Unit #15311 APO AP