DNV GL North America Family Assistance, Allegro Organizational Solutions

Application For Assistance from DNV GL Employee Support Program & Fund for Hurricane Harvey

The DNV GL Business Areas in the U.S.A. have established an Employee Support Program & Fund with Allegro Organizational Solutions (AOS), for DNV GL regular full-time and regular part-time employees who have suffered financial hardship as a direct result from Hurricane Harvey.

All applications will be reviewed by the DNV GL Application Review Committee who will determine eligibility for the Program and make recommendations for the award of grants from the fund. It is at the Committee’s discretion in conjunction with AOS to allocate the grant award amount amongst all listed categories, based on the number of eligible applications and size of fund pool. In addition to that described below, the Committee reserves the right to require additional supporting proof of loss if deemed necessary or desirable. All funding decisions of the Committee and AOS are final and confidential.

For your application to be accepted, all required supporting documents must be received.

Please be sure to review the attached Fund Overview Document, prior to starting your application

Fund Overview

Application submission deadline: Sunday, October 8th, 2017

Grants may be made for more than one (1) category of loss or damage. However, where more than one (1) family member is employed by DNV GL, only one (1) claim may be submitted per primary residence.

Step 1 of 3

Please share with us the following information, so that we at DNV GL May consider how to help you.

Applicant Name *

First

Last

I respectfully request assistance from the DNV GL North America Employee Support Program & Fund of AOS:

Employee I.D. *

Home Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Phone Number *

Please select the level(s) of assistance you wish to request

You will be required to provide the relevant proof for each category selected. The application will not be accepted if required proof is not provided at the time of application submittal.

1. LIVING EXPENSES

Living expenses incurred because of displacement from primary residence (e.g. hotel accommodation).

2. PERSONAL PROPERTY

Loss or damage to personal property, such as furniture, appliances, carpeting, clothing, and perishable foods where the total cost of replacement and/or repairs is not covered with proceeds from an insurance policy.

3. PRIMARY VEHICLE

Loss or damage to personal primary vehicle owned by you where the total cost of replacement and/or repairs are not covered with proceeds from an insurance policy.

4. PRIMARY RESIDENCE DAMAGE

Damage to primary residence owned and used by you. Damage must be the result of storm surge, rising floodwaters entering the residence, high wind, water leakage or falling debris. Damage must be to the structure and does not include contents (examples: sheet rock, flooring, roof leakage, etc.) Such damage must not be covered with proceeds from an insurance policy.

5. PRIMARY RESIDENCE LOSS

Loss of primary residence owned and used by you. Loss must be the result of storm surge, rising floodwaters entering the residence, high wind, water leakage or falling debris. Loss must be to the structure and does not include contents. Such Loss must not be covered with proceeds from an insurance policy.

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