Emergency Measures Organization - Damage Report Form

Residents in New Brunswick are advised to report damages caused by the Flooding starting on April 15, 2014

People in the Province whose property has suffered damage as a result of flooding starting on April 15, 2014 are requested by the Department of Public Safety's Emergency Measures Organization to report the damage to Service New Brunswick. These reports will assist officials with the assessment of damages.

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

If you need help filling out the form, please call 1-888-298-8555.

Enter the required information below and click "Submit".

* Required fields
Do you require a call back? Yes
* First Name:
* Last Name:
* Do you Own Rent or Lease
* If yes, is there any other owners? Yes No
  If yes, what is their name?
First Name:
Last Name:
* What type of property is this: Residential
Cottage
Apartment
Small business
Retaining wall
* Disaster:
  Parcel Identifier Number (PID - found on your property tax bill):
  Property Account Number (PAN - found on your property tax bill):
Address of damaged property:
Please enter Postal Code and search for Address
* Postal Code: ([Postal Code Trouble?])
* Is there a phone number that you can be reached during the day: ()  -
* Is there a phone number that you can be reached during the evening: ()  -
Do you have a cell phone number? ()  -
What is your email address?
* When did this damage happen? Date:
* What was the cause of this damage (description):
* Language of written correspondence English French
Residential Property (check one or more): Loss or damage to residence
Loss or damage to personal property/contents
Residence was evacuated
Residence is not habitable
Erosion
* Do you need to be evacuated from your home? Yes No
If YES, call 9-1-1.
* Do you still have power at the property you are reporting? Yes No
If No, was it turned off by:
Qualified Electrician or NB Power
* If you have been evacuated are you Staying with friend or family?
  Name:
  Telephone Number: ()  -
  Red Cross Shelter?
  Shelter Name:
  N/A
* Does anyone living in this household have a medical condition? Yes No Prefer not to answer
If yes, what?
Commercial Properties (check one): Farm
Small business
Non-profit organization
Commercial Properties (check one or more): 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
* Have you reported the losses and damages to your insurance company? Yes No
What is the estimated dollar amount of damage:
Additional Information if a flood
Units of Measure
How deep was the water?
What level?
Basement
First floor
Other
Description of "Other":
* Was there sewer back-up? Yes No
Do you have any comments and additional information?
* Date:


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