Referral Form_LIFT Eligibility Criteria: Family with at least one member being a Singaporean/ Singapore PR is living in a 4-room HDB flat or smaller Family has a gross per capita income (PCI) of $625 per month or less At least one child is receiving formal education (Primary/ Secondary/ Tertiary level) 1. Main Person’s Details Title Mrs Ms Mr Dr Miss Mdm Prof Rev Dr Full Name (As Per NRIC) * Preferred NameGenderFemale Male Marital Status Address Address * Postal Code Contact Nos. HomeOffice Mobile * Email * Living Arrangement Room HDB flat1234Housing StatusRent Purchased Putting up with friends/ relatives Others If Housing Status is Others please specifyGross Monthly Household IncomeGross Monthly Per Capita IncomeOther sources of incomeRental incomeCPF payoutsPension paymentsPayouts from insuranceMaintenance paymentsNILMonthly amount of Other sources of income 2. All household members’ Particulars (Including main person) NameDate of BirthAgeRelationship to Main Personbrother/sister/father/motherOccupationFull Time/ Part time/ OthersTo state employment or study type (i.e. contract, leave of absence from school, dropped out of school, etc.)Education LevelMonthly Gross IncomeTotal no. of household members 3. Family’s Current Situation (including strengths, needs and concerns) Family’s Current SituationAdditional Remarks Submit Cancel
