To join the FAP programme, please complete the YDA’s Financial Assistance Application Form below. Financial Assistance Programme Application Form Part I- Particulars of Applicant 第一部份— 申請人資料Full name 姓名(Required)In English中文姓名Gender 性別(Required)Male 男Female 女Date of birth (dd/mm/yyyy) 出生日期 (日/月/年)(Required) Membership no. 會員號碼(Required)Type of diabetes 糖尿病類型(Required)Type 1 一型Type 2 二型Other 其他 (please specify 請註明)If other, please specify(Required)Follow-up hospital 覆診醫院(Required)Doctor in-charge 主診醫生(Required)Other disease (if any) 其他疾病 (如有)School 就讀學校(Required)Year of study 就讀年級(Required)Reason for application 申請原因(Required)Contact person 聯絡人姓名(Required)Contact person no. 聯絡人電話(Required)Relation with applicant 與申請人關係(Required)Email 電郵(Required) Address(Required) Flat, Floor, Block, Building Street Village/Town/District Region Part II- Family Background 第二部份— 家庭背景Accommodation status 居所類別(Required)Public housing 公共房屋Private housing 私人樓宇Self-owned 自置Others 其他Monthly rental fee 每月租金/ Mortgage 按揭供款(Required)Other 其他 (Please specify 請註明)(Required)Marital status of parents 父母婚姻狀況(Required)Married 已婚Divorced 離婚Widow/ er 喪偶Other 其他 (請註明)Other 其他 (Please specify 請註明)(Required)Family members residing with applicant 與申請人同住的家庭成員(Required)1234Family member [1] 同住家庭成員 [1](Required)Name in English 英文姓名Name in Chinese 中文姓名[1] Relation 與申請人關係(Required)[1] Current status 現況(Required)In employment 就業Unemployed 失業Retired 退休Student 在學[1] Income of family member residing with the applicant 與申請人同住的家庭成員收入(Required)Company 公司名稱Position 職位Full-time/ part-time 全職/兼職Office tel no. 辦公室電話Annual income (HK$) 全年總收入(港幣$) Add RemovePlease provide the income of the last 12 months. Include any explanatory note within the fields – e.g.: If unemployed or retired, please enter ‘N/A’ 請填上過去12個月期間的收入 請在欄位內加入任何說明文字——例如：「如屬失業或退休，請填寫『N/A』」[1] Year of study 就讀年級(Required)[1] Chronic disease 長期疾病(Required)(If not applicable, please fill in ‘X’ ) (如沒有，請填上「X」)Family member [2] 同住家庭成員 [2](Required)Name in English 英文姓名Name in Chinese 中文姓名[2] Relation 與申請人關係(Required)[2] Current status 現況(Required)In employment 就業Unemployed 失業Retired 退休Student 在學[2] Income of family member residing with the applicant 與申請人同住的家庭成員收入(Required)Company 公司名稱Position 職位Full-time/ part-time 全職/兼職Office tel no. 辦公室電話Annual income (HK$) 全年總收入(港幣$) Add RemovePlease provide the income of the last 12 months. Include any explanatory note within the fields – e.g.: If unemployed or retired, please enter ‘N/A’ 請填上過去12個月期間的收入 請在欄位內加入任何說明文字——例如：「如屬失業或退休，請填寫『N/A』」[2] Year of study 就讀年級(Required)[2] Chronic disease 長期疾病(Required)(If not applicable, please fill in ‘X’ ) (如沒有，請填上「X」)Family member [3] 同住家庭成員 [3](Required)Name in English 英文姓名Name in Chinese 中文姓名[3] Relation 與申請人關係(Required)[3] Current status 現況(Required)In employment 就業Unemployed 失業Retired 退休Student 在學[3] Income of family members residing with the applicant 與申請人同住的家庭成員收入(Required)Company 公司名稱Position 職位Full-time/ part-time 全職/兼職Office tel no. 辦公室電話Annual income (HK$) 全年總收入(港幣$) Add RemovePlease provide the income of the last 12 months. Include any explanatory note within the fields – e.g.: If unemployed or retired, please enter ‘N/A’ 請填上過去12個月期間的收入 請在欄位內加入任何說明文字——例如：「如屬失業或退休，請填寫『N/A』」[3] Year of study 就讀年級(Required)[3] Chronic disease 長期疾病(Required)(If not applicable, please fill in ‘X’ ) (如沒有，請填上「X」)Family member [4] 同住家庭成員 [4](Required)Name in English 英文姓名Name in Chinese 中文姓名[4] Relation 與申請人關係(Required)[4] Current status 現況(Required)In employment 就業Unemployed 失業Retired 退休Student 在學[4] Income of family members residing with the applicant 與申請人同住的家庭成員收入(Required)Company 公司名稱Position 職位Full-time/ part-time 全職/兼職Office tel no. 辦公室電話Annual income (HK$) 全年總收入(港幣$) Add RemovePlease provide the income of the last 12 months. Include any explanatory note within the fields – e.g.: If unemployed or retired, please enter ‘N/A’ 請填上過去12個月期間的收入 請在欄位內加入任何說明文字——例如：「如屬失業或退休，請填寫『N/A』」[4] Year of study 就讀年級(Required)[4] Chronic disease 長期疾病(Required)(If not applicable, please fill in ‘X’ ) (如沒有，請填上「X」)Part III- Others Assistance or Allowance 第三部份—已申領的援助/ 津貼Applicant 申請人: Type of allowance 已申請援助/ 津貼(Required) Jockey Club Support for Young People with Diabetes 賽馬會年輕糖尿支援 計劃 Comprehensive Social Security Assistance (CSSA) Scheme 綜合社會保障援助計劃 Social Security Allowance (SSA) 公共福利金計劃 (每月金額) Government Assistance 政府資助 Other Supplement (Annual): 其他補助金(全年) None of the above Please state the subsidy amount 請填上資助金額(Required)Applicant 申請人: Which Social Security Allowance (SSA) do you receive? 已申請的公共福利金計劃(Required) Disability Allowance 傷殘津貼 Old age (/Living) allowance 高齡津貼/ 長者生活津貼 Transport Supplement 交通補助金 Please state the subsidy amount 請填上資助金額(Required)Family Member [1] 同住家庭成員[1]: Type of allowance 已申請援助/ 津貼(Required) Jockey Club Support for Young People with Diabetes 賽馬會年輕糖尿支援 計劃 Comprehensive Social Security Assistance (CSSA) Scheme 綜合社會保障援助計劃 Social Security Allowance (SSA) 公共福利金計劃 (每月金額) Government Assistance 政府資助 Other Supplement (Annual): 其他補助金(全年) None of the above Please state the subsidy amount 請填上資助金額(Required)Family Member [1] 同住家庭成員[1]: Which Social Security Allowance (SSA) do you receive? 已申請的公共福利金計劃(Required) Disability Allowance 傷殘津貼 Old age (/Living) allowance 高齡津貼/ 長者生活津貼 Transport Supplement 交通補助金 Please state the subsidy amount 請填上資助金額(Required)Family Member [2] 同住家庭成員[2]: Type of allowance 已申請援助/ 津貼(Required) Jockey Club Support for Young People with Diabetes 賽馬會年輕糖尿支援 計劃 Comprehensive Social Security Assistance (CSSA) Scheme 綜合社會保障援助計劃 Social Security Allowance (SSA) 公共福利金計劃 (每月金額) Government Assistance 政府資助 Other Supplement (Annual): 其他補助金(全年 None of the above Please state the subsidy amount 請填上資助金額(Required)Family Member [2] 同住家庭成員[2]: Which Social Security Allowance (SSA) do you receive? 已申請的公共福利金計劃(Required) Disability Allowance 傷殘津貼 Old age (/Living) allowance 高齡津貼/ 長者生活津貼 Transport Supplement 交通補助金 Please state the subsidy amount 請填上資助金額(Required)Family Member[3]同住家庭成員[3]: Type of allowance 已申請援助/ 津貼(Required) Jockey Club Support for Young People with Diabetes 賽馬會年輕糖尿支援 計劃 Comprehensive Social Security Assistance (CSSA) Scheme 綜合社會保障援助計劃 Social Security Allowance (SSA) 公共福利金計劃 (每月金額) Government Assistance 政府資助 Other Supplement (Annual): 其他補助金(全年 None of the above Please state the subsidy amount 請填上資助金額(Required)Family Member [3] 同住家庭成員[3]: Which Social Security Allowance (SSA) do you receive? 已申請的公共福利金計劃(Required) Disability Allowance 傷殘津貼 Old age (/Living) allowance 高齡津貼/ 長者生活津貼 Transport Supplement 交通補助金 Please state the subsidy amount 請填上資助金額(Required)Family Member [4] 同住家庭成員[4]: Type of allowance 已申請援助/ 津貼(Required) Jockey Club Support for Young People with Diabetes 賽馬會年輕糖尿支援 計劃 Comprehensive Social Security Assistance (CSSA) Scheme 綜合社會保障援助計劃 Social Security Allowance (SSA) 公共福利金計劃 (每月金額) Government Assistance 政府資助 Other Supplement (Annual): 其他補助金(全年) None of the above Please state the subsidy amount 請填上資助金額(Required)Family Member [4] 同住家庭成員[4]: Which Social Security Allowance (SSA) do you receive? 已申請的公共福利金計劃(Required) Disability Allowance 傷殘津貼 Old age (/Living) allowance 高齡津貼/ 長者生活津貼 Transport Supplement 交通補助金 Please state the subsidy amount 請填上資助金額(Required)Part IV- Supplementary Information 第四部份—補充資料Please prepare and send your supporting documents within 7 working days of submitting this application form, clearly stating your name, to YDA at fap@yda.org.hk. 請於提交本申請表後 7 個工作天內，將所需證明文件電郵至 fap@yda.org.hk，並請於電郵中清楚註明你的姓名，以便跟進處理。Supporting documents 證明文件 (please select all that apply)(Required) Medical certificate for diagnosis of diabetes (For first-time applicants only) 糖尿病醫生證明（只適用於首次申請） Full time study proof (For tertiary/university students only) 全日制在學證明文件（只適用於大專或大學生） Income proof of family members within the same household 與申請人在港同住家庭成員之收入證明（最近一年的糧單或稅單副本） Proof of monthly housing rental fee/mortgage payment (if applicable) 居所的每月租金或按揭供款證明（如適用） Medical proof of applicant/ family members residing with the applicant having other disease(s) (if applicable)申請人/ 同住家庭成員的長期疾病證明（如適用） Proof of other government subsidies (if applicable) 其他政府資助證明(如適用) Please note: 1. An affirmation made at the Hong Kong Home Affairs Department is required for the parent of an FAP applicant who declares no income proof or is self-employed.) 若申請人的同住家庭成員屬於自僱人士或無法提供收入證明，須前往民政事務總署宣誓，並交回宣誓書予本 會。 2. YDA reserves the right to conduct further means tests. 備註：本會保留作出進一步資產審查之權利 Declaration 聲明(Required) I certify that the information provided is true and complete, and that I have read and understood the following Terms and Conditions. 本人證明以上所提供的資料屬實且完整，並已閱讀及明白以下條款及細則。Terms and Conditions 條款及細則 1. Effective from 1 April 2026, members of this programme must participate in at least one YDA activity during each half‑year period (a total of at least two activities per year) to ensure eligibility for membership renewal. 由 2026 年 4 月 1 日起，本計劃之會員必須於上、下半年分別參與至少一項 YDA 活動（全年至少兩項），以確保符合獲取補助資格。 2. Successful applications will be granted a 1‑year term subsidy (for applicants aged 25 or below). 每份成功的申請為期一年。 3. A maximum of HK$1,800 will be granted for every 3‑month period. 資助金額以 3 個月作為一週期，每期最高資助額為港幣 $1,800 元正。 4. Approval or rejection of the application is subject to the discretion of YDA. 本會擁有批核的最終決定權。 5. YDA reserves the right to amend the terms and/or cancel this Programme at its discretion without notice. 本會保留更改或取消本計劃而毋須作出任何通知及解釋。 6. If there is overpayment due to error of calculation, applicants are liable to refund the overpaid amount. 尚若因計算而導致申請人獲多發放資助，申請人必須退還多付之款項。 7. YDA staff may conduct home visits to understand the condition of the applicant’s family. 本會職員或會到訪申請人家庭進行家訪了解申請人家庭狀況。 8. YDA may contact other organisations, including the employers of the applicant and their family members, to authenticate the information provided. Any misrepresentation or concealment of facts may lead to disqualification. 本會或會聯絡申請人及其家庭成員的僱主，核對填報的資料。申請人若在申請表內誤報或漏報資料，其申請資格將會被取消。
