Widow Registration Form

Full Name

Date of Birth

Age

Address

Contact Number

Email Address (Optional)

Marital Status

Widow

Other (Please specify)

Please specify your marital status

National ID Number / Voter ID / Other ID

Next of Kin Name

Phone Number

Are you currently receiving assistance from any other organization?

Yes (Please specify)

No

Please specify the assistance you are receiving

Preferred Method of Contact

Phone Call

SMS

Email

Preferred Registration Method

Online

Download Form

Register at Office

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

I have read and agree to the Terms and Conditions.

Signature

Clear

Date

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

Widow Registration Form

Terms and Conditions

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