Halliburton Energy Services, Inc./Transocean Punitive Damages & Assigned Claims Settlements

Administrative Forms

  • Change of Address/Change of Name Form
  • Authorization for Release of Claims Information — Claimants may use this form if you wish to consent to the release of your claims information and documents to a third party.
  • Legal Representative Certification — Claimants may use this form if you wish to submit a claim or receive information on behalf of a claimant who is deceased, a minor, or incompetent.
  • Claimant Request for Change in Representation Status – Claimants may use this form if you wish to update your attorney representation status.
  • Dissolved Business Certification – Claimants may use this form to certify the dissolution or sale of a business.
  • Form W-9 — Claimants and attorneys are required to provide a completed Form W-9 in which the name on the W-9 matches the name provided to the Claims Administrator for the Claimant in order to receive payment.
    If the IRS confirms that the name and Social Security number (SSN) or name and employer identification number (EIN) do not match the name in the IRS records you may be required to provide an updated W-9 and an IRS Verification of Taxpayer Identification Number prior to receiving payment or be subject to 24% backup withholding.
  • Attorney’s Payment Election Form & Change of Firm Information Form — Attorneys may file this form to update the information on file for the firm name, address, and payment election options that previously were utilized by the DHEPDS. NOTE: This form is for ATTORNEY USE ONLY. If a Claimant submits this form, any information provided will not be processed.
  • Rules Governing the Third Party Claims Dispute Resolution Process - These procedures define the process for resolving certain disputes as to whether a Third Party Claimant is entitled to be paid out of the affected Claimant’s Settlement Payment and/or as to the amount of a Third Party Claim. This is the process by which lienholders, judgement holders, attorneys, and claims preparers may file a claim against a claimant’s proceeds for consideration and adjudication within the program if not already being submitted pursuant to a court order.
  • Rules Governing the Resolution of Claims on Behalf of Deceased, Minor, or Incompetent Claimants - This procedure defines the process by which the Claims Administrator(s) will process and/or pay the claims of Deceased Claimants, Minor Claimants, and Incompetent Claimants. The Joint Motion and Order will be provided only after the Claims Administrator deems it necessary as part of the follow-up process – do not attempt to draft a Joint Motion and Order and provide it to the Program.
  • Request for Third Party Dispute Resolution Form – Third Party Claimants may submit this form to request Third Party Claim Dispute Resolution for Fee Liens for services performed in connection with a Settlement Program claim.
  • Third Party Dispute Withdrawal Form – Parties subject to a Third Party Dispute Resolution process may submit this form if, at any time before a Final Decision is entered, the parties reach an agreement.

The documents above are in PDF format. Acrobat Reader is required to view the PDF. You may already have the Adobe Acrobat Reader on your computer or on disks that came with your computer. If you do, you won't need to download Adobe Acrobat. If you do not have Acrobat, you may download the Free Adobe Acrobat Reader.

To request that a form be mailed to you, please call the helpline at 1(877) 940-7792, or send an email to questions@GulfSpillPunitiveDamagesSettlement.com. You may submit your completed and signed form in one of three ways:

By Mail:

HESI/Transocean Punitive Damages & Assigned Claims Settlements
PO Box 10260
Dublin, OH 43017-5760

By Overnight, Certified or Registered Mail:

HESI/Transocean Punitive Damages & Assigned Claims Settlements
c/o Administrator
5151 Blazer Parkway Suite A
Dublin, OH 43017

By Email: