United Way of Greater Nashua

BAE Systems Employees Helping Employees Fund Application for Assistance

Name: Home Address:

Work e-mail: Home e-mail:

Home/Contact Phone: Cell Phone:

Please describe in detail your losses that were caused by a disaster:

Please specify the amounts you are requesting from the Employees Helping Employees Fund using the following categories: (See Page 2)

I request $ for Temporary Housing (describe how you will use these funds):

I request $ for Property Repair (describe how you will use these funds): Note, these funds may only be requested for your primary residence.

I request $ for Property Replacement (describe how you will use these funds): Note, these funds may only be requested for your primary residence.

I request $ for Other Assistance (describe how you will use these funds):

Insurance Information:

Insurance Company(s):

Insurance Agent: Agent Phone:

Address of Damaged Property:

NOTE: If you are requesting more than $5000 in assistance, please attach proof of ownership (tax records, mortgage payment book, or a copy of your home owner’s insurance policy for the address showing you as the owner). If proof of ownership documentation has been destroyed, then alternative arrangements can be made to verify property ownership. No documentation you submit will be provided to BAE Systems. Funds may be paid out in several payments over time, rather than in one lump sum payment.

I hereby acknowledge that this Application for Assistance from the BAE Systems Employees Helping Employees Fund is for uninsured losses sustained by me. I attest that the information I have provided in this Application is accurate and true to the best of my knowledge, and that I may be required to provide additional information to United Way of Greater Nashua regarding my losses or insurance coverage before funds can be disbursed. I agree to use any funds awarded me for the purposes I have expressed above.

Signed:______Date:______

United Way of Greater Nashua

BAE Systems Employees Helping Employees Fund Information Sheet

TYPES OF ASSISTANCE:

The following list describes the types of assistance available from the BAE Systems Employees Helping Employees Fund when efforts to obtain assistance from insurance and/or FEMA have been exhausted.

Temporary Housing (a place to live for a limited period of time) – Money is available to rent a different place to live, or a government provided housing unit when rental properties are not available.

Repair – Money is available to homeowners to repair damage from the disaster that is not covered by insurance. The goal is to make the damaged home safe, sanitary, and functional.

Other Assistance – Money is available for necessary expenses and serious needs caused by the disaster.

TYPES OF ELIGIBLE LOSSES:

The Employees Helping Employees fund may cover the repair or replacement of items that are damaged as a direct result of the disaster that are not covered by insurance. Repairs or rebuilding may not improve your home above its pre-disaster condition unless such improvements are required by building codes.

Housing Needs: The Employee Helping Employees fund will pay to return your home to its pre-disaster condition. You may use your money provided for housing needs to repair:

o  Windows, doors, floors, walls, ceilings, cabinetry

o  Utilities (electrical, plumbing, and gas systems)

o  Blocking, leveling, and anchoring of a mobile home and reconnecting or resetting its sewer, water, electrical and fuel lines, and tanks

Other Than Housing Needs: Money to repair damaged personal property or to pay for disaster-related necessary expenses and serious needs is limited to items or services that help prevent or overcome a disaster-related hardship:

o  Disaster-related funeral and burial cost

o  Clothing; household items (room furnishings, appliances); tools (specialized or protective clothing and equipment) required for your job

o  Clean-up items (wet/dry vacuum, air purifier, and dehumidifier)

o  Moving and storage expenses related to the disaster (moving and storing property to avoid additional disaster damage while disaster-related repairs are being made to the home)

IMPORTANT INFORMATION:

  1. Money received from the BAE Systems Employees Helping Employees Fund must be used for eligible expenses only. The money received is intended for uninsured losses only. Any subsequent reimbursement from insurers or the government for losses funded by BAE Systems Employees Helping Employees Fund must be returned to United Way of Greater Nashua.
  1. Funds received from the BAE Systems Employees Helping Employees Fund may be taxable (please check with your financial advisor).
  1. Funds from the BAE Systems Employees Helping Employees Fund may not be reassigned or transferred to another person without permission of United Way of Greater Nashua.
  1. Before you begin repairs, check with your building department to find out what local permits or inspections are required.

SUBMITTING THE APPLICATION:

Once the application is finalized, please submit using one of the following methods:

1)  Email the application to:

2)  Mail the application to: United Way 20 Broad Street, Nashua, NH 03064

For additional information on filling out the application, please call 603-882-4011,United Way of Greater Nashua, Inc.

2 | Page