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Registration Form
Apply for The
PE Link Service
FAQ About The
PE Link Service
About The PE
Link Charitable
Fund
Sharing from
Beneficiaries
Registration Form
Apply for The PE Link Service - Registration Form
Name of Applicant* :
Male
Female
Day Time Contact Tel No* :
< User information >
Name* :
Male
Female
Age* :
I.D.No.* :
(
)
Home Tel.* :
Mobile :
Address* :
(* must fill in)
Are you living alone?
Yes
No
Name of Co-habitant(s)
Relationship of Co-habitant(s) :
Age :
Are you a recipient of CSSA?
Yes
CSSA No. :
C
No
Rental
(Monthly rental plus monthly service charge are HK$100)
How do you get known about this website? (must fill in)
Newspaper (Please Specify) :
Magazine (Please Specify) :
TV (Please Specify) :
Radio (Please Specify) :
Poster
Leaflet
ROADSHOW
Minibus
Online Search Engine (Please Specify) :
Friend's Recommendation
Annual Report
Social Service Agencies (Please Specify) :
Others (Please Specify) :
I hereby agree and authorize Senior Citizen Home Safety Association to provide my information to Social Welfare Department and Housing Society for applying the emergency alarm special allowance.
Remarks : Above information will be used for applying the Personal Alarm System only.