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Wheelchair Application Form

Free of charge ยท Takes about 15 minutes ยท All fields marked * are required

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Step 1/7: Personal

1 Personal Information

Format: YYMMDD-PP-XXXX. Date of birth and gender will be auto-detected.

2 Residential Address

City & state will auto-fill

3 Disability Information

Minimum 50 characters

Attending Doctor / Medical Officer

4 Socioeconomic Information

This information is kept strictly confidential and used only to determine eligibility.

RM

5 Wheelchair Requirements

Minimum 100 characters. Be as detailed as possible.

0 chars

6 Upload Documents

Accepted formats: PDF, JPG, PNG. Maximum file size: 5MB per document.

Click to upload or drag & drop

5MB max โ€” PDF/JPG/PNG

Click to upload or drag & drop

5MB max โ€” PDF/JPG/PNG

Click to upload or drag & drop

Pay slip, employer letter, or Surat Akuan JKM

Click to upload or drag & drop

2MB max โ€” JPG only, white background

Click to upload or drag & drop

5MB max โ€” PDF/JPG/PNG

7 Declaration & Submission

Application Summary

Name
โ€”
IC
โ€”
State
โ€”
Wheelchair Type
โ€”

Applicant Declaration (Akuan Pemohon)

I hereby declare that all information provided in this application is true, complete and accurate. I understand that providing false information may result in rejection of my application or withdrawal of the wheelchair. I consent to BKRRM contacting my doctor to verify my medical information.

Step 1/7
๐Ÿ‡ฒ๐Ÿ‡พ MALAYSIA MADANI
Kementerian Kesihatan Malaysia

MINISTRY OF HEALTH MALAYSIA

MINISTER'S WELCOME MESSAGE

YB Menteri Kesihatan

YB DATUK SERI DR. HAJI

DZULKEFLY AHMAD

Minister of Health Malaysia

22 April 2026

Peace be upon you and blessings of Allah. Greetings to all Malaysians.

Alhamdulillah, we are grateful to Allah SWT for His blessings that enable us to collectively support the Malaysian Wheelchair Aid Programme (BKRRM). This initiative manifests civil society's commitment in addressing healthcare challenges, particularly for those requiring mobility assistance.

I wish to express my highest appreciation to the Malaysian People's Welfare Association (PKRM) for their firm commitment in contributing 350 wheelchair units for use in government hospitals and health clinics nationwide. This noble effort not only helps ease patients' burdens but also strengthens our public healthcare delivery ecosystem.

In line with the MADANI Government's aspirations, the Ministry of Health Malaysia (KKM) continuously supports active participation from strategic partners and NGOs. Basic facilities such as wheelchairs are critical elements in ensuring patient comfort, safety, and smooth movement within healthcare facilities.

May this programme achieve its objectives and serve as a catalyst for more welfare initiatives in the future. May all these noble efforts be blessed by Allah SWT. Thank you.

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