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Widow Registration Form

Join our mission to support widows in need. Complete the form below or download it to apply for our upcoming assistance program.

Widow Registration Form
Marital Status
Are you currently receiving assistance from any other organization?
Preferred Method of Contact
Preferred Registration Method

Terms and Conditions

This program is exclusively for widows aged 65 and above residing in Sango Ota. Registration is limited to 100 individuals for this cycle. Upon successful registration, beneficiaries will be issued an ID card.

Important Guidelines:

  • Beneficiaries must present their ID card every last Wednesday of the month to receive food and monetary assistance.
  • Without the ID card, food and money will not be distributed.
  • ID cards are non-transferable and must not be shared with others.
  • The Heart Span Aid Outreach Foundation reserves the right to modify the program's terms and conditions as needed.

By signing below, you acknowledge that you have read, understood, and agree to abide by these terms and conditions.

Agreement

* Fields marked with an asterisk (*) are mandatory.

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