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HMCC JKT Benevolence Fund Application Form
All information inserted into this form will be kept confidential and will only be accessed by pertinent members of the Benevolence Team (i.e. PIC, two members, church elders).
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* Indicates required question
Name
*
Your answer
Phone number (Please start with country code, e.g. for Indonesia 628 (add number))
*
Your answer
Email address
*
Your answer
Home address
*
Your answer
Date of birth
*
MM
/
DD
/
YYYY
Gender
*
Female
Male
Marital status
*
Never married
Married
Widowed
Divorced
Spouse's name (If applicable)
Your answer
Child(ren)’s name(s) and age(s) (If applicable)
Your answer
Family members living with you (Please state name and relationship) (If applicable)
Your answer
Category (if relevant)
Orphan
Disabled
Refugee/asylum seeker
Are you a believer in Jesus Christ?
*
Yes
No
Are you a member of HMCC?
*
Yes
No
If you are not a member, are you a regular attender of HMCC?
Yes
No
Clear selection
If you are a regular attender of HMCC, how long have you been attending this church?
Your answer
Are you part of LIFE Group?
*
Yes
No
If yes, who are your LIFE Group leaders?
Your answer
Have you been helped by our Benevolence Fund before?
*
Yes
No
If yes, please list your case number or describe the extent of help
Your answer
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