BFP Regional/City/

Regional/City/Municipal District/Municipal
LOGO Station Letterhead LOGO

FIRE INCIDENT CERTIFICATION

(For affected structure)

TO : Fire Victim / Requesting Party

(Name of Requesting Party/Fire Victim)

THIS IS TO CERTIFY that the (Type of Occupancy) of (Name of

establishment), owned / operated by (Name of Owner or Operator) was affected /
damaged by the fire that transpired on or about (Time and Date of Fire Incident ) at
(Exact Location of Fire Incident).

This Fire Incident Certification was issued this ____________________, upon

the request of, (Name of Requester), (Designation in establishment) – (Name of
Owner or Operator) for (Purpose of Request (Insurance Claims/Termination of
Business/Reconstitution/Renewal)) to (Name of Institution documents will be
submitted to) with (Indicate Policy No. for Insurance Claims) and for whatever legal
purpose it may serve.

For any verification or inquiry, the investigation of this fire incident was
undertaken by the (Name of Office, Division), (Name of Directorate), BFP (Name of
Region) with office address at (Address of Office).

(Rank and Name of C, CFM/DFM/PFM)

(Designation)
(Name of Directorate)
BFP (Name of Region)

Not Valid Without

BFP - Dry Seal