Apply For Assistance

Application for Assistance

Please take a moment to fill out the form. Please include any documents with the file upload at the end of the form.

Applicant Name

Select an Address

Cell Phone

Home Phone

Driver's License #

Class #

Date of Accident

Location of accident

Type of assistance you are requesting/how can we be of help

In making this application for assistance, I hereby certify that:

I was not intoxicated by any substance or driving in a reckless or unsafe manner

All above statements are true and correct to the best of my knowledge.

The following items must accompany your application before approval can be given or any funds released: 1. Copy of valid Nova Scotia Driver’s license 2. Copy of valid insurance 3. Copy of police report (police incident number as well if an urgent request for financial assistance) 4. Doctor's note stating injuries

***Please no graphic images***

Upload File

Upload supported file (Max 15MB)

Your Signature

Thanks for submitting!

Application Administrator - Tracy Gauvreau

tracylgauvreau@gmail.com

902-229-8834

General email - bikersdownnovascotia@gmail.com

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Application for Assistance

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