Home Loss Questionnaire

If you have lost your primary home, vacation home or business, please fill this out so that we might get a general idea of the cost of the losses due to this fire. The total value of losses will allow us to provide that information to various provincial and federal agencies that deal with recovery.

There is nothing on this form that is ‘required’ so if you don’t want to provide your name/contact info, that’s ok, but we won’t be able to target specific help in your direction should some become available.

Although this form is geared towards residential losses, business losses can also be captured here.

This is not a CSRD information form.
Thanks.

Name *

First

Last

Email *

Phone

Items Lost

Address of Loss

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Are you renting at this address

Is this a residence or business?

Residence
Business

Is this your primary and only residence

Estimated Value of home

Do you have home insurance?

General list of other items lost

We don’t need all the details but in broad strokes, are there other buildings that have been lost, cars, equipment etc. We may ask for verification of items, for instance if you say you lost a Ferrari, you may have to back that up.

Estimated Value of other items

Do you have contents insurance?

Your current accommodation

Are you currently in the North Shuswap

Are you settled for

Short term only
Longer term (thru the winter)

Please explain

NorthShuswap.Info

Community Communication

Home Loss Questionnaire

Items Lost

Your current accommodation

Your needs