Manitoba Infrastructure

Application for Disaster Financial Assistance

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Application for Disaster Financial Assistance

Any personal information you provide through the Emergency Measures Organization Disaster Financial Assistance (DFA) application is collected in compliance with The Freedom of Information and Protection of Privacy Act. The personal information you provide is used only for the purposes for which it is collected, and not in any other way without your consent.

This information is collected as part of the applicant's request for Disaster Financial Assistance. Emergency Measures Organization has responsibility for administering the Disaster Financial Assistance program as per The Emergency Measures Act.

Find more information refer to the Disaster Financial Assistance information webpage.

Applicant Information

Claimant Name:

Must be name(s) that appear on property tax or rental agreement.

Mailing Address: City, Town, Village:

Province:

Please Specify:

Postal Code:

Is the contact person's name different than above? Yes No

Contact Person's Name:

Phone Numbers

Primary Number:

Name:

Secondary Number:

Name:

Tertiary Number:

Name:

Email Addresses

Primary Email:

Name:

Secondary Email:

Name:

Date of Loss or Damage

From:

To:

Type of Event

Example: Flood, heavy rains, windstorm, tornado, etc.

Damaged Property Information

According to the Property Tax Bill for the damaged property, is the property address different than the address given above? Yes No

Address(es) of Damaged Property according to Property Tax Bill(s):

Local Authority of Damaged Property:

Other Local Authority:

Tax Roll Number(s) of Damaged Property:

Claim Information

Claim Type: Home Farm Business Non-profit Organization

Home Claim

Applicant Type: Homeowner Tenant

Number of occupants evacuated:

Evacuated From Date:

Evacuated To Date:

Is this application for damage to my principal residence? Yes No

Is the home habitable? Yes No

Farm/Business Claim

Please check all that apply: My farm or business has gross annual revenues between $10,000 - $2,000,000 per year. I am the day to day manager of my farm or business. My damages are for crop losses only.

Do you own or rent the damaged property: Own Rent Own and Rent

Briefly describe the damages and / or losses:

What is the source of flooding? Overland Flooding

Occurs when water flows over land and enters a building through windows, doors or any other opening in a building. Overland flooding is typically caused by an overflowing body of water or excess surface water from snowmelt or rainfall when surface and underground infrastructure is unable to drain excess water.

Seepage

Occurs when water enters building below ground level by seeping through cracks, small holes, joints or porous materials in building foundations. Seepage is typically caused by a rise in the underground water table.

Back-up or Escape of Water / Sewage

Occurs when either water or sewage escape or back-up through a sewer, septic system, plumbing system, sump pump, sump pit, weeping tiles or floor drain. Back-up may be caused by a number of factors, including but not limited to:

Damage to sewer mains or connectors
Overload of municipal sewer systems
Overload of domestic sump or septic pumps
Failure of domestic sump or septic systems due to power or mechanical failure
Groundwater entering through sewer systems, septic systems, sump systems, weeping tiles or floor drains

Were you at the property when damage occurred? Yes No

What was the depth of the water?

Basement: Feet: Inches:

Main Floor: Feet: Inches:

Have you contacted your insurance provider? Yes No

Briefly describe the status of your insurance related to the damages:

Please click the SUBMIT button to submit your application for Disaster Financial Assistance to Manitoba Emergency Measures Organization for preliminary assessment. A written confirmation that your application is received will be sent to you within two weeks.

If you do not receive this confirmation, please contact Manitoba Emergency Measures Organization at (204) 945-3050 or toll-free at 1-888-267-8298.

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