马来西亚大爱社区众筹平台求助表格
Persatuan Kebajikan Amal Da Ai Malaysia -
Assistance Request Form
任何种族、信仰、宗教，都能够向马来西亚大爱社区众筹平台申请求助，大爱平台在收到求助个案后会联系当事人，并进行家访商讨援助方式。
Regardless of any religion or race, you are welcome to submit the form to request help from Da Ai Malaysia. We will contact you after received the application and conduct home visit to discuss further on how Da Ai can help with.
日期 Date *
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求助者姓名 Requester's Name *
求助者电话号码 Requester's Contact Number *
求助者年龄 Requester's Age *
求助者地址 Requester's Address *
求助者职业 Requester's Occupation *
求助者薪资 Requester's Income *
病情/求助事项 Disease / Issue Facing *
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