ESPERANCE FIRES APPEAL
ASSESSMENT OF CLAIMS
Preamble
Assistance is available to residents of the Shire of Esperance who
suffered personal hardship due to the loss or damage to their place of
residence, other property, furniture or personal effects as a result of the
Esperance Fires.
The Lord Mayor’s Distress Relief Fund (the “Fund”) aims to assist individuals
to effect repairs to their residences and to restore normal living conditions as
quickly as possible. Assistance is made in the form of financial grants.
Assistance is in addition to any insurance cover that you may have for your
property. People requesting assistance should first claim from their insurance
company.
The Fund cannot fully compensate those who have suffered loss because of
no or inadequate insurance cover.
Categories of LMDRF Assistance which may be considered
 Grants may only be provided to cover repairs to a place of residence to
make them safe and habitable, and to compensate for the loss or damage
to furniture and personal effects.
 Assistance can be paid in respect to occupiers (e.g. farm workers) who lost
personal property (e.g. clothing, equipment, furniture) as a result of the fire.
 Please note that the Fund is not established to assist business operations
(eg. crop losses, destroyed machinery) that have been impacted by the fire.
Support may be available through the Western Australia Natural Disaster
Relief and Recovery Arrangement (WANDRRA) and other State
Government arrangements.
 Please note that if your place of residence is also your place of work, eg.
Farm house/outbuildings etc., eligibility will only be for personal effects and
non-business related losses (eg. water, retic, gardens, power,
communication and fencing to and around your place of residence).
2015 Esperance Fires
Who Decides On My Claim
A Local Recovery Committee has been established from representatives of
the Shire of Esperance. This Committee receives and assesses claims and
makes recommendations to the Board of the Lord Mayor’s Distress Relief
Fund on an appropriate grant for individual claims.
Your Local Recovery Committee (LRC) members are:
Cr. Victoria Brown
Cr. Natalie Bowman
Cr. Lara McIntyre
Cr. Beverley Stewart
Cr. Basil Parker
Matthew Scott
Terry Sargent
Mel Ammon
President of the Shire of Esperance (Chair)
Shire of Esperance
Shire of Esperance
Shire of Esperance
Shire of Esperance
CEO, Shire of Esperance
Director External Services, Shire of Esperance
(Recovery Coordinator)
Manager Law and Order, Shire of Esperance
(Deputy Recovery Coordinator)
Please be aware that the final decision regarding the extent of
assistance for each claim rests with the Board of the Lord Mayor’s
Distress Relief Fund.
Points to Remember
 The Lord Mayor’s Distress Relief Fund assists individuals.
 The Fund completely relies on public donations and any grants made to
you will be relative to the total donated amounts.
 All associated operational costs and administration of the Fund are donated
by the City of Perth. This means that every cent collected is disbursed to
those who affected by the fires.
 A grant is designed to compensate for personal loss and distress.
 Please help your LRC by filling out the application form as detailed as you
can, giving details of the loss and distress incurred.
 If you consider you are eligible for assistance and wish to apply, please
lodge your claim quickly.
 If you are in doubt or have any queries whatsoever on the scheme, ask
your LRC or the Shire of Esperance for clarification. This will ensure you
get the correct information.
ASSISTANCE APPLICATION FORM – ESPERANCE FIRES
2015 Esperance Fires
Where do I Apply?
Written claims need to be posted to
Chief Executive Officer
Shire of Esperance
PO Box 507
ESPERANCE WA 6450
Claims can also be lodged at the Shire of Esperance offices at Windich Street,
in Esperance.
Signed documents will be accepted if emailed to shire@esperance.wa.gov.au
ASSISTANCE APPLICATION FORM – ESPERANCE FIRES
APPLICATION FOR ASSISTANCE
ESPERANCE FIRES APPEAL
LOCAL RECOVERY COMMITTEE
Mr / Mrs / Ms / Miss / Dr / other
Your Full ................................................................................................................
Name
................................................................................................................
Your Current
Mailing
................................................................................................................
Address –
where can we
..............................................................................
...........................
send your
Post Code
mail?
Your
Occupation ................................................................................................................
Contact Phone ................................................. Mobile: ...............................................
Numbers:
Your Account Name: .....................................................................................
Bank Account
Details
BSB: ................................. A/C No: ..................................................
ASSISTANCE APPLICATION FORM – ESPERANCE FIRES
2015 Esperance Fires
Where any of your responses fill more than the space(s)
provided, please write on a separate page and
attach to this application.
This claim is in respect to the damaged property located at .............................................
.................................................................................................................................................
.................................................................................................................................................
which is my place of residence and of which I am the registered OWNER OWNER & OCCUPIER - OCCUPIER (please circle the description appropriate
to your situation), and where the following people - who are wholly dependent
on me - also reside:
Name
Age
Relationship
Please list the loss or damage sustained
Description of damaged items
Estimated
Value
Approximate percentage of the property impacted by the fire _______%
If insurance cover is held, please answer the following:
ASSISTANCE APPLICATION FORM – ESPERANCE FIRES
2015 Esperance Fires
Have you lodged an insurance claim?
YES
or
NO
Name of Insurer: ........................................................................................................
Type of insurance cover held: .................................................................................
Value of Policies: $ .....................................................................................................
Other information- Describe any other non financial impacts (e.g. distress &
hardship) that the event has had. (attach separate statement if required)
......................................................................................................................................
......................................................................................................................................
......................................................................................................................................
To assist your Local Recovery Committee in assessing your application,
please provide a summary of assistance (financial or otherwise) you have
already received or applied for in connection with this fire.
......................................................................................................................................
......................................................................................................................................
I certify the above information is correct and seek assistance from the
Lord Mayor’s Distress Relief Fund for the abovementioned losses
sustained as a result of the 2015 Esperance Fires.
...............................................................................
/
Signature of Applicant
/
Date
I verify that the information contained in this application is true and correct
and I support the Local Recovery Committee’s recommendation of
Level ........................
...............................................................................
Matthew Scott, CEO
Shire of Esperance
/
/
Date
ASSISTANCE APPLICATION FORM – ESPERANCE FIRES