APPLICATION FOR
ASSISTIVE TECHNOLOGY FUND
Before you fill in this form, please take note:

Assistive Technology Fund (ATF) provides subsidies for persons with disabilities (PWDs)
to acquire, replace, upgrade or repair assistive technology devices.

ATF covers PWDs, for assistive technology devices, for purposes of early intervention,
education, training, open or supported employment, therapy, rehabilitation and/or
independence in daily living.

Successful applicant qualifies for a subsidy of up to 90% of the cost of assistive technology
devices, subject to a cap of $40,000 over the applicant’s lifetime. The subsidy amount is
means-tested.

The application form consists of 3 sections. Please refer to overleaf for the eligibility
criteria and instructions before completing the attached application form.

Applicants will require the assistance of an assessor and recommender from a
touchpoint such as hospitals and voluntary welfare organisations to complete the
form. Completed application and all the required supporting documents as indicated
overleaf, are to be submitted through the touchpoint.
Please submit completed form either by Post or Email to:
BY POST: SG Enable – Assistive Technology Fund
20 Lengkok Bahru #01-01
Singapore 159053
BY EMAIL: ATF@sgenable.sg

Successful ATF applicants who require further subsidy can be considered for the Special
Assistance Fund from the National Council of Social Service using this same application
form.
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APPLICATION FOR ASSISTIVE TECHNOLOGY FUND FOR PERSONS WITH DISABILITIES
(Please retain this page for your information)
Eligibility
 Singapore Citizen or Permanent Resident



Certified to have a permanent disability of any one of the following:
o Physical disability
o Visual impairment
o Hearing impairment
o Intellectual disability
o Autism Spectrum Disorder
Undergone qualified assessor’s assessment to determine the need and type of device(s)
Household monthly income per person of $1,800 and below
Supporting documents

Section 1 (Applicant’s Information) should be signed by the applicant or caregiver if applicant is below
21 years old/ mentally incapacitated.


Clear photocopy of the applicant’s NRIC (Front and Back) or Birth Certificate

Clear photocopy of the Caregiver’s NRIC (Front and Back) for applicant who is below 21 years old/
mentally incapacitated.
Completed Means-Test Declaration Form. Form can be obtained from www.sgenable.sg
(Note: You do not need to submit the Means-Test Declaration Form if you have a valid means-test
results within the past two years)
o
Touchpoint may assist you in completing the Means-Test Declaration Form. In such
scenarios, touchpoint will submit Means-Test eligibility result to SG Enable

Section 2 (Assessor’s Report) is to be filled by qualified assessor indicating applicant’s disability
information and recommendation of device OR
o Any other latest supporting documents by qualified assessor stating permanence and type of
disability, as well as recommendation of device


Vendor’s quotation(s) to be provided by touchpoint showing full cost of device(s)

Section 3 (Recommender’s Report) is to be filled by recommender and endorser from touchpoint
showing other application information and subsidy disbursement
Vendor’s invoice(s) to be provided by touchpoint showing full cost of device(s). (Note: Original or
certified true copy of invoice is only required after application approval. SG Enable will inform
touchpoint of the application approval and request for the invoice thereafter to facilitate subsidy
disbursement.)
Important Notes
2
Terms and Conditions
1. Completed application form must be submitted through a touchpoint via either one of the following:
Post:
SG Enable – Assistive Technology Fund
20 Lengkok Bahru #01-01
Singapore 159053
Email:
ATF@sgenable.sg
2. SG Enable reserves the right to query and request for further information on any application.
3. Applications that are incomplete, without the required documents or arising from unauthorised
touchpoints may not be processed or may be rejected.
4. Upon receipt of the completed application form and ALL required supporting documents, the
application will typically be processed within 15 working days. Touchpoint will be informed of the
application outcome via email.
5. New touchpoints are advised to approach SG Enable on the application process.
6. For any further information and query, you may reach us via Infoline at 1800-8585885 or
email contactus@sgenable.sg. You may visit our website at www.sgenable.sg.
Updated on 1 Nov 2015
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APPLICATION FOR ASSISTIVE TECHNOLOGY FUND
SECTION 1: APPLICANT’S INFORMATION
* Check  where appropriate
I – PARTICULARS OF APPLICANT
Family Name:
Given Name:
NRIC/Birth Cert
No.
*Citizenship:
☐ Singaporean ☐Permanent
Resident
D.O.B
/
(DD/MM/YYYY)
/
*Gender:
Contact
(Mobile):
☐Male ☐Female
Contact
(Home):
Address:
Address Unit
No:
#
Postal
Code: S
-
(#0-0 if there is no unit no.)
Email:
*Present
Occupation:
☐
☐
Student
Self-employed
☐
☐
National Service
Unemployed
☐
☐
Employed
Others (Specify):
II – DECLARATION AND CONSENT
☐
*I would like to receive mailer from or/and be contacted by SG Enable for related services and schemes in
the future.
I declare that all information provided is true and correct and I have disclosed all necessary information relevant to the
application.
I hereby give my consent for SG Enable to use my personal data including but not limited to my name, NRIC, contact
number, mailing and email address as well as other information provided in the application for the purposes of processing
my application for the Assistive Technology Fund, Special Assistance Fund and any applicable supplementary funds.
I give my consent for SG Enable to share my personal data and the information provided in the application with other
relevant agencies for the purposes of my application and/ or the administration and provision of services and schemes to
me, and/ or data analysis, evaluation and policy formulation, in which I shall not be identified as specific individual.
I am aware that SG Enable has the right to recover in full any subsidy given to me under the Fund if I have provided
inaccurate information, or withheld any relevant information required for this application.
Applicant/ Caregiver Name:
Signature/Thumbprint:
Date (DD/MM/YYYY):
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APPLICATION FOR ASSISTIVE TECHNOLOGY FUND
SECTION 2: ASSESSOR’S REPORT
If this section is not filled up by a Therapist/Optometrist/Audiologist/Doctor, please ensure Part V is
completed.
* Check  where appropriate
I – PARTICULARS OF APPLICANT
Name:
NRIC/
Birth Cert No:
II – DISABILITY INFORMATION
*Types of disability:
☐ Physical Disability
☐ Hearing Impairment
☐ Autism Spectrum Disorder
☐ Intellectual Disability
☐ Visual Impairment
☐ Others (Specify):
Description
of condition:
(e.g. Limb Amputation, Muscular Dystrophy, Glaucoma)
*Nature of disability:
☐Permanent ☐Temporary ☐Suspected ☐Unknown
For temporary disability: Indicate estimated recovery period (e.g. 12 mths)
III – RECOMMENDATION OF DEVICE
Recommended device(s) should meet one or more of the outcomes listed below:
1. Aid in early intervention/ education
4. Aid in therapy
2. Aid in training
5. Aid in rehabilitation
3. Aid in open/supported employment
6. Increase independence in daily living
No.
Device description
Please state model
name
Accessories
included?
Yes / No
Yes / No
Yes / No
Device outcome
Choose outcome from list
above and check one or more
that applies.
☐
1.
☐
4.
☐
2.
☐
5.
☐
3.
☐
6.
☐
1.
☐
☐
2.
4.
☐ 5.
☐
3.
☐
☐
1.
☐ 2.
☐
☐
☐
3.
Net cost of
device ($)
Please include
GST where
applicable.
Has device
been
purchased prior
to application?
Quotation
reference no.
If available
Yes / No
Yes / No
6.
4.
☐ 5.
Yes / No
6.
5
No.
Device description
Please state model
name
Accessories
included?
Device outcome
Choose outcome from list
above and check one or more
that applies.
1.
2.
☐
☐
☐
4.
5.
☐
3.
☐
6.
☐
1.
☐ 2.
☐
☐
☐
☐
Yes / No
Yes / No
3.
Net cost of
device ($)
Please include
GST where
applicable.
4.
☐ 5.
Has device
been
purchased prior
to application?
Quotation
reference no.
If available
Yes / No
Yes / No
6.
Remarks (if any):
(e.g. Elaborate how device will benefit applicant, justification of chosen AT etc)
Please provide vendor’s quotation of device. SG Enable may seek for further quotes as and when required.
IV – ASSESSOR INFORMATION
I confirm that the assessment done for the above applicant is true and correct to my best knowledge. I am
aware that the assessment for this application will serve as reference. SG Enable reserves the right to make
the final decision on the application outcome and reject any application if the information is found to be
inaccurate, or if any relevant information has been withheld by applicant.
Name of
Assessor:
Designation:
Organisation:
Contact No:
Email:
Signature:
Date of
recommendation:
V –THER
V – OTHERS (Please fill below if this section is not completed by a Therapist/Optometrist/
Audiologist/Doctor).
Comments:
(Please state why in your view that a Therapist/Optometrist/ Audiologist/Doctor report was not necessary. e.g. Applicant is
recommended a repair/replacement/ upgrade of device)
Please provide any medical documents stating permanence and type of disability where available. SG Enable
may seek further clarification and/or document if necessary.
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APPLICATION FOR ASSISTIVE TECHNOLOGY FUND
SECTION 3: RECOMMENDER’S REPORT
This section is to be filled up by staff from touchpoint.
I – PARTICULARS OF APPLICANT
Name:
NRIC/Birth Cert No:
II – OTHER INFORMATION
1.
Funding % requested for1:
(Please indicate % requested based on your assessment of applicant’s financial ability.)
Is applicant able to co-pay? 2 Yes / No
2.
(Please provide details on how much applicant can co-pay. If applicant is unable to co-pay, please indicate whether he/she has
access to any co-payment alternatives such as instalments or external funding.)
Does applicant receive any financial assistance?3 Yes / No / Unknown
3.
(State scheme, subsidy band and validity period e.g. PA/MFEC/MFAC/Medifund/Comcare. Provide supporting documents where
available.)
Any other source of subsidy applied for?
Yes / No
4.
(Double funding for same device is not permitted. If yes, give details on subsidy source(s) and % applied.)
For applicants 60 years and above only
Has subsidy been sought from other funds such as AIC SMF or HDB Ease?
Yes / No
5.
(Please provide details on subsidies sought/not sought)
Additional remarks (if any):
6.
1,2,3
The
information
provided
will
allow
SG
Enable
Special Assistance Fund or other applicable supplementary funds.
to
assess
applicant’s
financial
ability
for
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III – SUBSIDY DISBURSEMENT
We hereby consent and authorise SG Enable to disburse all approved subsidy to the party named below
as provided by us.
Cheque Payee Name:
Cheque mail to:
(State payee name)
Mailing Address:
Remarks on cheque
disbursement (if any):
Touchpoint will be informed of subsidy disbursement for all applications.
IV – RECOMMENDER AND ENDORSER INFORMATION
We acknowledge that subsidy will be disbursed only after receipt of invoice by SG Enable. We agree to inform SG
Enable immediately if there is any change to the application after it is submitted.
We have verified all information and supporting documents submitted by applicant to be true and correct to the best
of our knowledge. SG Enable reserves the right to make the final decision on the application outcome and reject any
application if the information is found to be inaccurate, or if any relevant information has been withheld.
Recommended by:
Endorsed by:
Recommender
name:
Endorser
name:
Designation:
Designation:
Email:
Email:
Contact number:
Contact number:
Signature/Date:
Signature/Date:
Org:
Org:
Org
address:
Org
address:
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