LRFA

Latvian Relief Fund of America


LRFA is a professionally managed, non-profit, mutual assistance organization, designed to provide our members with affordable health care plans and financial assistance in emergencies. We support other Latvian-American organizations and education in the U.S. and abroad.
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Emergency Assistance Fund

Current LRFA members are eligible for financial assistance in cases of natural disaster or other catastrophic events. Complete the application form below to be considered for these benefits. After submitting this form, you may be contacted by LRFA for further information.

Benefit Request

Please provide the following information: (Red indicates a required field)

Your Information
First Name Middle Initial
Last Name
Membership #  
Mailing Address
Address (line 2)
City
State/Province Zip/Postal Code
Country
Telephone E-Mail Address
 
Disaster Information

After completing this information, you may email us with supporting documentation and/or photos of the damage (homeowners insurance claim, estimates for repairs, etc).
Damage sustained due to:
Hurricane
Tornado
Flood
Fire
Earthquake
Other*

*Please explain nature of event:
Date of event: 
Please explain in detail the damage that occurred to your property:
Estimated cost of property damage: 
Are you the sole owner of the damaged property?
Yes  No   If no, please explain: 
Do you have any insurance coverage under which a claim for this incident may be made?
Yes  No
  If yes, please provide details: 
Are you eligible for support from any of the following agencies?
FEMA
State Government
Municipal/Local Government
Other
 
If you checked any of the above agencies, please explain:

Please email the following supporting documents to info@lrfa.org:
Owners report
Photos of damage
Repair estimates
Other

Questions and Comments:

Your Signature:
By submitting this form, I agree to all the terms of the LRFA Emergency Assistance Fund and certify that the above information is complete and true to the best of my knowledge.

 

© 2017 LRFA   -   P.O. Box 8857, Elkins Park, PA 19027-0857   -   info @ lrfa.org

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