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Elderly Services


Section 1: Applicant’s Details


Civil Status


Additional Information

(please attach a copy):   

Contact Details


Section 2: Details of Relatives

Kindly list details of spouse if applicable, and children. In case of no children list siblings




Section 3: Please tick (✔ ) which service you require

Kindly read carefully
Services which are marked with the note “Medical Report Required” indicate that in order to apply, Section 4 – Medical Report of this application must be completed by your family doctor and endorsed with an official stamp and his/her signature respectively.
























For Active Ageing Centres (Reference 1), please indicate Locality


For Home Help Service provision (Reference 2), please indicate who lives in the residence in Section 2 and also submit a Medical Report for every person over 65 years residing in the same residence.


For Telecare+ Service (Reference 6a), kindly fill in and submit as well the following:

Filled Telecare+ application form (click here to download document)
Copy of a valid Pink Form issued by the Department of Social Security or a copy of a valid Yellow Card issued by the Department of Health proving that applicant is diabetic (if applicable)
Copy of Identity Card
Medical report signed by a General Practitioner (if person is under sixty years of age)


For Telecare on the Move Service (Reference 6b), kindly fill in this application form and also submit the following documents:

Medical report signed by a General Practitioner
Copy of a valid Pink Form issued by the Department of Social Security, if available


Section 4: Medical Report (To be filled by a Doctor as applicable)

Medical Report (click here to download document)

Medical Report:   
Medical Report:   
Medical Report:   
Medical Report:   

Other Documents to be uploaded

Telecare+ application filled in and signed:   
Identity Card (Front):   
Identity Card (Back):   
Pink Form:   
Yellow Card:   
Special Identity Card:   

Declaration

Declaration Form (click here to download document)

Signed Declaration Form:*   

To receive a copy of the application, type your email address below


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 Contact 
      Active Ageing and 
      Community Care
      Ċentru Servizz Anzjan
      3, Old Mint Street
      Valletta VLT 1510
 
 Contact Numbers
      Freephone 153

      Tel. 22788800
 
 Email