DAP-Individual | FGS Nan Hua Temple

Disabled Assistance Project

Application for Individual

Application form from individuals completed and signed by the recipient and/or applicant;
Clear copy of the recipient's ID/birth certificate (for children);
Motivational letter, signed by the recipient or applicant;
1x Passport-size photo of the recipient attached to the application, top right corner;
Clear full length photo of the recipient;
BLIA terms and conditions form signed and dated at the bottom of the page by the applicant;
"Thank you letter to BLIA on delivery of the donated items.

ALL FORMS MUST BE CLEARLY FILLED IN AND SIGNED BY APPLICANT.
HOSPITAL/CLINIC FORM TO BE FILLED IN AND SIGNED BY DR/PHYSIO/NURSE AND WRITE THE PR NUMBER
CLEAR COPY OF ID/BIRTH CERTIFICATE OF RECIPIENT.
CLEAR FULL LENGTH PHOTO OF RECIPIENT.
SIGNED MOTIVATION LETTER EXPLAINING THE REASONS OF DISABILITY.
RECIPIENT PREPARE ACKNOWLEDGEMENT LETTER UPON DELIVERY OF WHEELCHAIR, CRUTCH OR WALKER.
Fulfil ONE of the conditions:
1. Attach the recipient’s medical history
2. Attach signing Doctor’s medical licence
3. Attach initial medical report when the incident happened.

For more queries, contact Zando on 013 931 0009/072 506 3435, dap@nanhua.co.za