Caregiver Support Programme

Application Form

* required fields

Know someone who needs support?

Do note that CaringWheels is currently only able to support caregivers in following areas: Hougang, Ang Mo Kio & Toa Payoh.

If you or someone is outside of the focus areas, you can still contact us to be better informed of available resources in Singapore!
For any enquires, feel free to reach out to our team! support@caringwheels.limited or call +65 6224 2296.

Personal Particulars

Full Name (as in NRIC)

Salutation

Mrs

Mdm

Nationality

Singaporean

Singapore PR

Others

Gender

Male

Female

Others

Date of Birth

Contact Number

Postal Code

Unit No.

Address

Care Recipient Details

I am also a Care Recipient

Wheelchair-Bound (Self)

Yes

Details of Care Recipient Special Requirements (Self)

How many Care Recipients do you have? (excluding Self)

Care Recipient 1

Full Name (as in NRIC)

Gender

Male

Female

Others

Date of Birth

Contact Number

Wheelchair-Bound

Yes

Details of Care Recipient Special Requirements

2nd Care Recipient

Full Name (as in NRIC)

Gender

Male

Female

Others

Date of Birth

Contact Number

Wheelchair-Bound

Yes

Details of Care Recipient Special Requirements

Assessment Details

Employment

Employed

Self-Employed

Not Employed

Household Monthly Income

Annual Value of Residence

What assistance do you require?

Please indicate other support you are already receiving

To facilitate a smoother process, please prepare the following documents for your meeting with our Care Officer.

Last 3 months Payslip
CPF 12months report
Annual value of residence
Functional Assessment Report (FAR) (optional)
Doctors’ Memo (Optional)
Front and back NRIC of caregiver and care recipients

Declaration & Acknowledgement

* I declare that all the particulars stated above are true to the best of their knowledge

* I consent to be contacted by CaringWheels in regards to the referral

* I have read and agree to the CaringWheels' Terms and Conditions and Privacy Policy