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Your Eligibility Form has been sent successfully. You will receive a confirmation email shortly at the email address you provided to us.
 
After we complete our review of your Eligibility form, we will contact you to let you know if you are eligible to submit claims for compensation to asbestos trusts.

Asbestos Trusts Compensation Eligibility Form

This questionnaire asks for the bare minimum of information necessary for ClearTrustClaims to determine if you may qualify for trust compensation.  Actually obtaining compensation will require that you and ClearTrustClaims work together to obtain the highly detailed additional information needed for asbestos trust applications.  ClearTrustClaims will be able to determine whether you are likely to qualify for compensation only after we have gathered the necessary detailed information.

If you are interested in contacting CTC to see if you might be eligible for compensation from asbestos trusts, please complete the following questionnaire.  When you have completed the questionnaire, click on the Submit button to send the information to us.

 Current Information

* Denotes required fields

 Medical Information

All of the asbestos trusts have very similar lists of medical conditions for which the trust will provide compensation. These conditions are asbestos-related diseases, including mesothelioma, lung cancer, a few rare other cancers, and breathing problems caused by damage to the lungs.

Have you been diagnosed with:

Mesothelioma or Lung Cancer?

Colo-rectal, laryngeal, esophageal, pharyngeal, or stomach cancer?

Asbestosis or severe asbestosis?

Scarring on both of your lungs?

Has any of your doctors told you that your medical condition is due to asbestos?

 Military Service

If you served in the military, please provide the following information:

 Civilian Employment

Please provide the following information about any civilian employment that you believe may have involved exposure to asbestos.

 Additional Information

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