Disaster Relief Application

Applicant Info

Disaster Details

Damage & Family

Documents

Review & Submit

Step 1: Applicant Information

Search Applicant (Head of Family) * Format: "Dela Cruz, Juan" or just "Dela Cruz"

Full Name

Date of Birth

Age

Gender

Civil Status

Contact Number

Address

Barangay * Auto-filled from user record. Change if needed.

Step 2: Disaster Details

Type of Disaster *

Fire

Flood

Typhoon

Earthquake

Landslide

Armed Conflict

Other (specify)

When & Where

Date of Disaster *

Time (approx.)

Specific Location

Incident Report (if available)

Report No.

Report Date

Issuing Agency

For Fire incidents, BFP Fire Investigation Report is required. For other disasters, Barangay Certification is acceptable.

Step 3: Damage Assessment & Family

Damage Level *

No Structural Damage (Relief goods only)

Partially Damaged (ESA ₱10,000)

Totally Damaged (ESA ₱30,000)

House Ownership

Estimated Damage (₱)

Affected Family Members

Total Family Members *

Children (below 18)

Senior Citizens (60+)

PWD

Pregnant/Lactating

Evacuation Status

Currently Evacuated?

Assistance Requested *

Type of Assistance *

Amount (if cash)

Food Packs Qty

Assistance Details / Items

Step 4: Upload Documents

Valid ID

Drag & drop or click to upload

JPG, PNG, PDF (Max 5MB)

Barangay Certificate

Drag & drop or click to upload

JPG, PNG, PDF (Max 5MB)

Incident Report (BFP/Police)

Drag & drop or click to upload

JPG, PNG, PDF (Max 5MB)

Photos of Damage (optional)

Drag & drop or click to upload

JPG, PNG (Max 5MB)

Additional Remarks

Step 5: Review & Submit

Please review all information before submitting.

Applicant Information

Disaster Details

Damage & Family

Documents Uploaded

I certify that all information provided is true and correct. I understand that any false statement may result in the denial of assistance.