Copy/Design a FORM in PDF/Word

I have a physical form (see attached. A better PDF copy will be given soon). I need an electronic copy, preferably in Word doc, or PDF. If in PDF, I must be able to edit and change too. Must tell me which program was used. The layout must be relatively easy to update/change. NO NEED to replicate the chinese words. It is best that the form is exactly the same. However, it's ok if the spacing is a little bit off. It must have the same look & feel.