Flood impact data Question Title Question Title * 1. Contact details Name Address * Address 2 * Town/village * Postcode * Email Address Phone Number * Question Title * 2. Council tax number (if known) Question Title * 3. Scale and description of impact. Where/what rooms did the flooding take place? Question Title * 4. Was the property liveable? Yes No Question Title * 5. If no, was this longer than 48 hours? Yes No Question Title * 6. Have you previously been flooded at the same property? Yes No Question Title * 7. If yes, was this 2015, 2019 and/or 2020? Yes No Question Title * 8. Is buildings insurance in place? Yes No Question Title * 9. Are you able to claim from buildings insurance? Yes No Question Title * 10. Is contents insurance in place? Yes No Question Title * 11. Are you able to claim from contents insurance? Yes No Question Title * 12. Are you of state pension age or consider yourself vulnerable and/or disabled? Yes No To enable us to process your application please send through your bank details (preferably those which are used to pay your council tax with): Name Account Number Sort Code Along with photographic or video evidence of the flooding which took place in your home to floodline@derbyshiredales.gov.uk with the address as the subject field.If you are not able to provide this information, please call 01629 761100 (Monday-Friday 9am-4pm) and speak to customer services.Once we have received all the relevant information to support your claim, you will be be notified within 5 working days if successful and you will be notified within 5 working days of the outcome. Question Title * 13. Please tick the box confirming that the information you have supplied is true and accurate. You also confirm that you understand that anyone caught providing false or untrue information to gain grant money will face prosecution and any grant issued will be subject to claw back. Please tick Derbyshire Dales District Council takes your privacy seriously. We will treat all personal information provided in confidence and store it securely in accordance with the Data Protection Act 2018 and General Data Protection Regulations.For more information on how we process your personal data and your rights as a data subject, visit: www.derbyshiredales.gov.uk/privacy Done
