Financial Assistance Programme Reimbursement Claim Form

Please read the following notes carefully before submitting your claim.

For reimbursement of each period, please complete this form and attach valid official receipts showing the purchase of diabetes supplies on or before the deadline, details as below:

	Period 1	Period 2	Period 3	Period 4
Quarterly Period (Deadline of submission)	1/4 – 30/6 (31/7)	1/7 – 30/9 (31/10)	1/10 – 31/12 (the following year 31/1)	1/1 – 31/3 (30/4)

Subsidised items	Subsidy amount
Insulin injection pen, syringe and needle	Subsidy amount will be HK$1,800
Blood glucose testing strips, lancets and blood glucose meter
Alcohol swipes, diabetes medicine and Doctor’s consultation expenses on diabetes medical check-up

A photo of the official receipts for the above diabetes medical consumables purchased within the quarter must be emailed to YDA at fap@yda.org.hk on the same day as submitting this form. Invoices or delivery notes would NOT be considered official receipts.
All receipts must include the date, purchased items and the amount; cash register receipts are NOT acceptable.
A maximum of HK$1,800 for every 3 months will be granted.
Please keep the original receipts for your records.
All submitted information will not be returned to the applicant, whether the reimbursement is successful or not.
Effective from 1 April 2026, members of this programme are required to participate in at least one YDA activity during each half-year period (a total of at least two activities per year) to ensure their eligibility for membership renewal.
All decisions made by YDA are final.

Reimbursement Claim Form

Part 1：Particulars of Applicants 第一部份：申請人資料

Full name 姓名(Required)

English 中

Member no. 會員號碼(Required)

Parent/Guardian name 家長或監護人姓名(Required)

English 中

Contact no. 聯絡電話(Required)

Email(Required)

Hospital name 覆診醫院(Required)

Bank Account Name 戶口持有人姓名(Required)

Bank name and code 銀行名稱及編號(Required)

Bank account no. 銀行戶口號碼(Required)

Part 2：Reimbursement Details 第二部分：申請費用補助詳情

Reimbursement period (select one) 資助期 (請選擇其中一項)(Required)

Purchases item(s) 購買項目(Required)

Select all that apply 可選擇所有適用項目

1. Insulin injection pen, syringe and needle 胰島素注射筆、針筒及針咀

2. Blood glucose test strips, lancet and blood glucose meter 血糖試紙、採血針及血糖機

3. Alcohol swipes, diabetes medicine and Doctor’s consultation expenses on diabetes medical check-up 糖尿科覆診診金、糖尿科藥費及酒精棉片費用

1. Insulin injection pen, syringe and needle 胰島素注射筆、針筒及針咀(Required)

Receipt Date (DD/MM/YYYY) 收據日期

Hospital or Pharmacy 醫院或藥房名稱

Total Amount (HKD$) 總金額 (港幣)

2. Blood glucose test strips, lancet and blood glucose meter 血糖試紙、採血針及血糖機(Required)

Receipt Date (DD/MM/YYYY) 收據日期

Hospital or Pharmacy 醫院或藥房名稱

Total Amount (HKD$) 總金額 (港幣)

3. Alcohol swipes, diabetes medicine and Doctor’s consultation expenses on diabetes medical check-up 糖尿科覆診診金、糖尿科藥費及酒精棉片費用(Required)

Receipt Date (DD/MM/YYYY) 收據日期

Hospital or Pharmacy 醫院或藥房名稱

Total Amount (HKD$) 總金額 (港幣)

Total amount 總金額 (HK$)(Required)

Part 3: Activities Participation Record 第三部分：活動參與紀錄

Activity name and date 活動名稱及日期(Required)

Please list any activities you have participated in during the past 6 months. To remain eligible, members must join at least one YDA activity every 6 months. 請列出你於過去 6 個月內曾參與的活動。為確保符合獲取補助資格，會員必須於上、下半年分別參與至少一項 YDA 活動。

Part 4: Receipt Upload and Declaration

Please send your official receipts to YDA at fap@yda.org.hk on the same day as submitting this form. The receipts must clearly show the purchased item(s), receipt date, hospital or pharmacy name, and total amount (HKD). Claims will only be processed upon receipt of the required supporting documents. Late submission of receipts may result in the claim not being processed. 請於提交本表格當日內將購買之正式收據電郵至 fap@yda.org.hk。收據必須清楚顯示購買項目、收據日期、醫院或藥房名稱，以及總金額（港幣）。本會僅在收到所需證明文件後才會處理有關申請。若收據未能於指定期限內提交，該報銷申請可能不獲處理。