Food Aids Project – FAP ( Shah Alam/Klang )

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Name*
IC / Passport / PR No.*
Picture of identity document*
Accepted file types: jpg, jpeg, png, gif, bmp.
maximum allowed size: 4MB, support jpg, png, gif, bmp.
Age*
Mobile phone number*
For eg. 0128882222
Email
Residential Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Status*
- OKU
- Single parent
- Elderly living alone
Occupation
Company Name
Company Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Income/month (RM)
No of immediate family member staying together*
Family member consists of
Spouse*
Children*
Spouse's name
Spouse's IC / Passport/ PR No.
Spouse's age
Please enter a number from 0 to 100.
Spouse's mobile phone number
For eg. 0128882222
First child's name
First child's IC / Passport / PR No.
First child's age
Please enter a number from 0 to 18.
Second child's name
Second child's IC / Passport / PR No.
Second child's age
Please enter a number from 0 to 18.
Third child's name
Third child's IC / Passport / PR No.
Third child's age
Please enter a number from 0 to 18.
Fourth child's name
Fourth child's IC / Passport / PR No.
Fourth child's age
Please enter a number from 0 to 18.
Fifth child's name
Fifth child's IC / Passport / PR No.
Fifth child's age
Please enter a number from 0 to 18.
Sixth child's name
Sixth child's IC / Passport / PR No.
Sixth child's age
Please enter a number from 0 to 18.
Seventh child's name
Seventh child's IC / Passport / PR No.
Seventh child's age
Please enter a number from 0 to 18.
Household income/month (RM)
Payslip
Accepted file types: jpg, jpeg, gif, png, bmp, pdf.
maximum allowed size: 4MB, support jpg, png, gif, bmp, pdf.
OKU cert
Accepted file types: jpg, jpeg, gif, png, bmp, pdf.
maximum allowed size: 4MB, support jpg, png, gif, bmp, pdf.
CAPTCHA
By submitting this form, you hereby confirm that the information provided herein is accurate and complete. You hereby grant your consent that your personal information will be collected and processed by Yayasan WWRC for the purpose of charity activities.