Food Aid Request Form 粮食援助申请表
Do you know of someone in need this season? We want to help!
你知道在这个季节有什么人需要帮助吗?我们想帮助他们!

Kindly fill up the form below and we'll see to it that help is sent their way.
请填写下面的表格,我们将确保向他们提供帮助。

*Due to the EMCO SOP travel restriction, food aid can only be provided to residence residing in Puchong.
*由于EMCO 标准作业程序的限制,粮食援助只能提供给居住在蒲种区的居民。
Food Aid Recipient 粮食援助受惠者 #1
Kindly furnish us with the details of the person receiving the food aid.
Name 姓名 *
Mobile Number 联络电话 *
Age 年龄 *
Gender 性别 *
Nationality 国藉 *
Full Residential Address 住址 *
Postcode 邮政编号 *
Number of pax in family 家庭成员人数 *
Do list out the number of children and elderly (>60yo) in the family 请列出家庭中孩子和老人(大于60岁)的数量。
Are there any special needs in the family? 家庭中是否有任何特殊需求? *
(physically disabled 身体残疾, chronically ill 长期患病, single parent etc 单亲等)
Reason for applying for food aid 申请粮食援助的原因 *
I have another candidate to register 我还有另一名受惠者 *
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