OMB Approval Number: 1105-0102-2026

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The document is a claim form for the Guam Claims Program under the Guam World War II Loyalty Recognition Act, allowing individuals to file claims for compensation related to their experiences during World War II, including as survivors of decedents or as victims of various forms of mistreatment. It includes sections for claimant information, details about the claim type, residency status, and specific incidents such as internment, forced labor, personal injury, and rape. The form also outlines legal requirements and privacy statements regarding the information provided.

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Click ‘Get Form’ to open the OMB Approval Number: 1105-0102 in the editor.
Begin by filling out the 'Claimant' section. Enter your name, address, contact information, and date of birth accurately.
If applicable, complete the 'Legal Representative' section with the representative's details.
In the 'Type of Claim' section, check all relevant boxes that apply to your situation as a Survivor or Compensable Guam Victim.
Provide residency information in the 'Guam Residency' section. If you have lived in Guam, include dates.
Complete sections related to specific claims (e.g., Survivor of Compensable Guam Decedent or Compensable Guam Victim) by answering all questions thoroughly.
Review your entries for accuracy and completeness before signing in the presence of a notary public.

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Versions	Form popularity	Fillable & printable
2016	4.5 Satisfied (43 Votes)

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