Recovery and Resilience Grant Program EOI Form Preview

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Recovery and Resilience Grant Program EOI Form Preview Recovery and Resilience Grant Program EOI Form Preview Recovery and Resilience Grant - Expression of Interest * indicates a required field The Recovery and Resilience Grant will provide reimbursement of up to $20,000 to eligible owners of insured residential properties that were damaged by the cyclone to improve the resilience of residential properties against future disaster events. The following expression of interest is intended to gauge the level of interest in the impacted communities for the Recovery and Resilience Grant Program. This is not an application for grant assistance. Property owners who are under-insured and require assistance for cyclone debris clean-up and rebuild activities, rather than resilience activities, should advise in the comments field below. Once further information is available, including eligibility criteria and how to apply, a Recovery and Resilience Officer will be in contact with you. Recovery and Resilience Officers can be reached at [email protected]. This assistance is being provided through the jointly funded Commonwealth-State Disaster Recovery Funding Arrangements (DRFA). Eligibility Are you the owner of the residence impacted by STC Seroja? * ○ Yes ○ No Please note: if you answered no you are not eligible for this grant. Is the property impacted by STC Seroja insured? * ○ Yes ○ No Please note: if you answered no you are not eligible for this grant. Which Local Government Area is your property in? * ○ Shire of Carnamah ○ Shire of Koorda ○ Shire of Canarvon ○ Shire of Mingenew ○ Shire of Chapman Valley ○ Shire of Morawa ○ Shire of Coorow ○ Shire of Mount Marshall ○ Shire of Dalwallinu ○ Shire of Northampton ○ Shire of Dandaragan ○ Shire of Perenjori ○ City of Greater Geraldton ○ Shire of Shark Bay ○ Shire of Irwin ○ Shire of Three Springs ○ None of the above Please note: if your residence was not in one of the 16 LGA's listed above you are not eligible for this grant. Recovery and Resilience Grant - Expression of Interest Page 1 of 4 Recovery and Resilience Grant Program EOI Form Preview * indicates a required field Applicant * Title First Name Last Name Street/Lot Number * Street Name * Suburb * Post Code * Must be a number. Your email * Your mobile phone number * Alternate contact number Have you made a claim on your home building insurance policy? * ○ Yes ○ No Name of insurer * Policy number * Policy period * Claim reference number * Page 2 of 4 Recovery and Resilience Grant Program EOI Form Preview What is the status of your insurance claim? * ○ Pending ○ Settled ○ Declined Were, or are, roofing repairs required at your property? * ○ Roofing repairs required ○ Roofing repairs in progress ○ Roofing repairs completed ○ Unsure ○ No Have the repair works been submitted for building approval by your local government? * ○ Yes ○ No If so, has building approval been granted? * ○ Yes ○ No Are you interested in making upgrades to your home to make it more resilient to future disaster events? * ○ Yes ○ No Are you underinsured and will you require assistance for clean-up or repairs only? * ○ Yes, clean-up assistance ○ Yes, repairs ○ Yes, both ○ None Comments Please enter any information you think is relevan to your situation. Prior STC Seroja Applications If you have applied for one of the grants listed below we may be able to transfer any relevant documents to your Recovery and Resilience Grant application should you be eligible. Have you previously applied for the following STC Seroja assistance? ☐ STC Seroja - Primary Producer Recovery Grant (application reference will be CatC965-0000) ☐ Premier's Grant for Residential Relief (application reference will be Seroja0000Resident) ☐ No Page 3 of 4 Recovery and Resilience Grant Program EOI Form Preview If yes, please provide your application reference number. Please note Declaration Any person who knowingly and with intent to defraud the WA Government, submits an application for assistance containing any materially false information, or conceals for the purpose of misleading information concerning any fact material thereto, commits a fraudulent act, which is an offence under the Criminal Code (WA). I declare the information provided in this application and attachments, and any details subsequently provided, is true and correct. * ○ I confirm I declare I am the owner of the property damaged by STC Seroja listed on this application. * ○ I confirm I authorise the Department of Fire and Emergency Services to seek any additional relevant information it may require to process this application. * ○ I consent I hereby request and authorise any parties to supply such information as requested by the Department of Fire and Emergency Services. * ○ I consent Name * Title First Name Last Name Recovery and Resilience Grant Ineligible Unfortunately, based on your answers you do not meet the criteria for this grant. Please feel free to contact one of our Recovery and Resilience Officers for further information on other assistance you may be eligible for at [email protected] Page 4 of 4.
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