EMO - Damage Report Form

Residents in New Brunswick are advised to report damages caused by Flooding on June 29, 2023

To apply for Disaster Financial Assistance (DFA) for the Heavy Rainfall event happened on June 29, 2023, homeowners, small business and not-for-profit organization are asked to register their damage to Service New Brunswick. Once registered a DFA package will be mailed out to you.

Important health and safety information, and tips for flood clean-up, are available on the River Watch webpage at www.gnb.ca/RiverWatch.

Enter the required information below and click "Submit".

Required fields are indicated with an " * " and bordered in red.

Do you require a callback?

Disaster :

Your First Name:

Your Last Name:

Your preferred language of written correspondence:

English French

Are you the owner?

Yes No, I rent or lease

Is there any other owner?

Yes No

Other owner information

First Name:

Last Name:

What type of property is this?

Commercial Property Information

What type of property is this?

Choose one or more issue(s):

Loss or damage to building

Loss or damage to inventory

Loss or damage to equipment

Business is not operable

Damage to land in production (Farm only)

Erosion

Property Information

Property Account Number
(PAN - found on your property tax bill):

Don't know your PAN? Look it up here.

Parcel Identifier Number
(PID - found on your property tax bill):

Address of damaged property

Postal Code:

Civic Number:

Civic Number Suffix:

Apartment Number / Suite:

Street Name:

Street Type:

Street Direction:

Community:

Province:

Is your mailing address different than the damaged property address?

Yes No

Mailing Address

Postal Code:

Civic Number:

Civic Number Suffix:

Apartment Number / Suite:

Street Name:

Street Type:

Street Direction:

Community:

Province:

Phone number that you can be reached at during the day:

Phone number that you can be reached at during the evening:

Cell phone number:

What is your email address?

When did this damage happen?

What was the cause of this damage (description)?

Have you reported the losses and damages to your insurance company?

Yes No

Estimated damage amount

Additional Information

Measurement Unit:

Metric Imperial

What level was affected?

How deep was the water?

Basement

ft. in.

First floor

ft. in.

Other

ft. in.

Description of Other:

ELECTRONIC SIGNATURE

TYPING IN YOUR NAME AND ELECTRONICALLY SENDING THIS FORM CONSTITUTES YOUR ELECTRONIC SIGNATURE.

I accept

Signature

Date (yyyy/mm/dd)

If you are unable to enter your address, you can call the NBEMO Recovery Team at 1-888-553-8558 and they can assist you.