Beneficiary 受惠人 Beneficiary Profile Individual Prefix * Mrs. Ms. Mr. Dr. Mdm First Name 姓 * Last Name 名 * Date of Birth (出生日期） * NRIC（居民证号码） * Mobile number(手机号码) * Home Tel (住宅电话)Race (种族） - select Race (种族） - Chinese （华语） Indian （印度） Malay （马来） Others（其他） English (英语) Any illness? （任何疾病?）AsthmaCancerDepressionDiabetesDialysisHigh Blood PressureHigh CholesterolHandicapped/WheelchairIntestinal CancerMuscular DystrophyOsteoporosisUrinary IncontinenceOthers?Do you Cook? 你煮饭吗 - select Do you Cook? 你煮饭吗 - Frequently Sometimes No Alternate Day For elderly 60 years old & above not living with the children, how do the children support them every month? 60岁以上老人没有与子女同住，子女每月如何供养他们?Occupation & Gross Salary/If not working why (职业总收入/如果不工作，为什么)Is the household receiving other types of assistance? Yes/No (inculde amt per month) 该家庭是否接受其他类型的援助?是/否(含每月amt)Rental Cost (租金费用)Utilities Cost（水电杂费）S&C Cost (杂费)Emergency Contact Name（紧急联系人姓名）Relationship（关系）Number of household resident 共处人数Occupation & Income （职业和收入）Remarks（附注）Block Number 大牌号码Street Name 地址Unit Number (e.g. #123) 门牌Postal Code 邮政编码 Submit Cancel
