Section A: Applicant Information
Section A: 申请人资料
Full Name (As Per NRIC) (required) 全英文姓名 (须与身份证一致) (必填) Nama (wajib diisi)
NRIC Number (required) 身份证号码 (必填) No Kad Pengenalan (wajib diisi)
Home Address (required) 住家地址 (必填) Alamat Rumah (wajib diisi)
Contact Number (required) 联络号码 (必填) No. Telefon (wajib diisi)
Alternative Contact Number 其他联络号码(如有) No. Telefon
Marital Status (required) 婚姻状况:
Number of Household Members (required) 家庭成员人数 (必填) No. Isi Rumah (wajib diisi)
Section B: Background Information
Section B: 背景资料
How did you hear about the “Fulfilling 100 Wishes” programme? (required)您是如何得知耕心圆百梦计划? (必填)
Referrer / Organisation Details (if any): (Name, Contact Number, Relationship)推荐人 / 机构详情(如有):(姓名、联络号码、关系)
Section C: External Aid Information
Section C: 外部援助资料
Have you received any external aid? (required)您是否曾接受过任何外部援助? (必填)ZakatBingkasSTRJKMOthers/其他None
Please specify for others请具体说明其他事项
Type of Aid Received (required)受援助类型: (必填)Financial Assistance/现金援助Groceries/食物援助/干粮Medical Equipment/医疗援助/器材Milk/Daily Essentials/奶粉/生活必需品Others/其他
Please specify for others请具体说明其他事项
Section D: Wish Details
Section D: 圆梦计划详情
1. My Wish is to: (Please describe your wish in detail) (required)我的心愿是:(请详细描述您的心愿) (必填)
2. The reason I hope this wish can be fulfilled is because…(Please describe your wish in
detail) (required)我希望实现这个圆梦计划的原因是…… (请详细说明您的理由或目前面临的困难) (必填)
3. Once my wish is fulfilled, the change I hope to see is… (How will this wish improve your life or someone else’s?) (required) 圆梦计划实现后,我希望看到的改变是…… (必填)
Terms & Conditions
条件与细则
By submitting this form, you acknowledge and agree that:
- Submission of a wish does not guarantee approval or fulfilment.
- Only one wish per individual or household is allowed. Duplicate submissions will not
be accepted. - If shortlisted, you will be contacted within 1–2 weeks for an assessment, and may
need to provide supporting documents. - All submissions will go through a verification process to ensure eligibility and
authenticity. - Wish selection is based on feasibility, urgency, and available resources.
-
This programme is open to individuals in all Malaysia, including:
- B40 Group
- Persons with Disabilities (PWD)
- Homeless
- Chronically ill patients
- Orang Asli
- Single-parent families
- Former drug dependents
- Victims of domestic violence, etc.
- Personal information provided will be kept confidential and used only for programme
purposes. - By submitting, you consent to the use of your name, photos, and videos for
documentation and promotional purposes. - The organising committee reserves the right to approve, reject, or modify any wish.
All decisions are final. - Selected applicants may be invited to attend the Handover Ceremony (December
2026). - Urgent cases may be fulfilled earlier, before the ceremony.
- Terms & Conditions may be updated without prior notice.
提交此表格即表示您知晓并同意以下事项:
- 申请不代表保证: 提交心愿申请并不保证该心愿一定会被批准或实现。
- 申请限制: 每个人或每个家庭仅限申请一个心愿。重复提交将不予受理。
- 后续评估: 若进入候选名单,我们将在 1 至 2 周内与您联系进行评估,届时您可能需要提供相关的证明文件。
- 审核程序: 所有申请都将经过审核程序,以确保申请资格与资料的真实性。
- 筛选标准: 圆梦计划的筛选将基于可行性、紧急程度以及现有资源的分配。
- 申请资格: 本计划开放予全马的个人申请,包括:
- B40 群体
- 身障人士
- 流浪汉
- 病患
- 原住民
- 单亲家庭
- 戒毒者
- 家暴受害者等
- 隐私与个资保护: 您所提供的个人资料将被严格保密,且仅用于本计划之相关用
途。 - 宣传授权: 提交申请即表示您同意本机构将您的姓名、照片及视频用于记录、存
档及宣传用途。 - 最终决定权: 筹委会保留批准、拒绝或修改任何心愿的权利。所有决定均为最终
决定。 - 交接仪式: 入选的申请者或受邀出席于 2026 年 12 月举行的移交仪式。
- 紧急个案: 紧急个案可能会在仪式举行前提前落实。
- 修改权: 本条款与细则如有更改,恕不另行通知。
Declaration:
申请人声明:
- Proof of income
- Medical documents
- Identification documents
- 收入证明
- 医疗文件
- 身份证明文件

