Disaster Registration Form
Central Emergency Relief Organization, BNB Building, Cr James & Coleridge Street, Bridgetown, Barbados
Copyright © 2004 CERO. All rights reserved.
*Incident:
*Date:
*Name of Affected Person:
*Age:
*National ID Number:
*Address:
Addr
es
s Line 2:
Telephone Numbers: *Home/Work/Cell
(h)
(w)
(c)
*E-mail Address:
*Constituency:
St. Michael North West
*Problem:
*Assistance Required:
*Name of Person Making Report:
Contact Numbers: *Home/*Work/Cell
(h)
(w)
(c)
The House is:
Owner Occupied
Rented
Is the Property Insured?
Yes
No
*Number of Occupants in the Household:
Adults:
Children:
Is Alternative Accomodation needed?
Yes
No
Is Alternative Accomodation available?
Yes
No
Sign-Up Form
Fill out our form and you will be contacted with further information.
