NAIFA Hurricane Relief Fund Application

The NAIFA Hurricane Relief Fund is designed to provide immediate financial assistance to NAIFA members who have a residence or place of business impacted during the 2018 hurricane season.

Members must be in good standing of NAIFA as of September 1, 2018 to be eligible for financial assistance.

Please note, if both your primary residence and business were impacted as a result of the same hurricane event, you must apply for each entity separately.

A red asterisk (*) indicates a required field.

Member Name: *

First Name Last Name

Member ID: *

Phone Number: *

- Area Code Phone Number

E-mail: *

Which was affected by the hurricane event? *

Primary Residence Business

Name of Business: *

Physical Address of residence or business affected: *

Street Address
Street Address Line 2
City	State
Zip Code	Country

Parish/County:

The residence or business affected by the hurricane is/was: *

Owned by you Rented by you

Total personal household income level: *

Amount of water in residence or business: *

Please select ALL of the items that were damaged as a result of the disaster: *

Exterior of Home/Business (ex: roof, siding, windows, etc.) Appliances (ex: dishwasher, washer/dryer, refridgerator, etc.) Furniture Clothing Automobile(s)

Additional Comments regarding the impact, physical damage or financial need:

Are you in good standing of NAIFA as of September 1, 2018? *

Yes No

Please upload up to 6 pictures of your loss/damage:

Upload a File

I attest the information furnished above is true to the best of my knowledge. I also understand the Fund reserves the right to require and seek verification of information submitted on this application with my employer. Finally, I agree to confidentiality on the process and amounts granted to me through this employee grant process. *

Yes No

Address to which the relief check should be mailed, if approved: *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country