Application For Disability Schemes - Doctor'S Assessment Report printable pdf download

Application For Disability Schemes - Doctor'S Assessment Report

Application for Disability Schemes

Doctor’s Assessment Report

Section 1: Type of scheme applying for (please tick):

Foreign Domestic Worker (FDW) Levy Concession (Persons with disability)

Aims to provide support to families of persons with disability in employing full-time caregivers to assist

persons with disability in performing the activities of daily living (ADL). Eligible employers of FDW will

pay a monthly FDW levy of $170 under this scheme.

Person with Disability

Name: ______________________________________

NRIC/BC: ________________

Gender :

Male

Female

Date of Birth: ________________

FDW Employer

Name: _______________________________________ Contact No: __________________

Please send this report together with the completed application form via fax or mail to:

Centre for Enabled Living Ltd

No. 7 Maxwell Road, #05-08 Annexe B MND Complex, Singapore 069111

Website:

| Infoline: 1800-8585 885 | Fax: 6270 7024

Community Health Assist Scheme (CHAS)(Persons with disability)

Eligible persons with disability will be able to receive primary care from private General Practioners at

subsidised rates under this scheme.

Name of person with disability: ______________________ NRIC/BC: ________________

Address: __________________________________________________________________

Contact No: ______________

Please send this report together with the completed application form to:

Community Health Assist Scheme

P.O. Box 680

Bukit Merah Central Post Office

Singapore 911536

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Application For Disability Schemes - Doctor'S Assessment Report