Commission on Filipinos Overseas
Lingkod sa Kapwa Pilipino /
Link for Philippine Development (LINKAPIL) Program
Health and Welfare Intent Form
Name of Organization/Donor :
Contact Person :
Position :
Address :
Telephone :
Fax No. :
Email :
Intended Assistance :
Donation of Medical Supplies/Equipment
Please specify :
Donation of Medicine
Please specify :
Conduct of Medical Mission
Gift-Giving Activity
Feeding Program
Others
Please specify :
Preferred beneficiary/school/province :
Proposed Date/s of Mission :
Local Contact Person (if any) :
Telephone :
Fax No. :
Email :
For Medical Mission :
Type of Medical Service :
Medical
Dental
Optical
Minor Surgeries
Others, pls. specify :
Preferred beneficiary/school/province :
Local Contact Person (if any) :
Telephone :
Fax No. :
Email :
