本人愿意捐款作以下用途 I would like to donate for the following purpose(s)
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捐款用途 Donation Designation *
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捐款金额 Donation Amount *
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是否需要捐款收据? Receipt Required? *
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称呼 Salutation
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捐款者类别 Donor Categories *
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善长芳名 Name of Donor *
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电邮 Email *
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性别 Gender
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年龄 Age
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联络电话 Telephone No. *
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手提电话 Mobile Phone No.
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传真 Fax No.
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室 Flat/Room
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楼 Floor
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座 Block
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大厦/楼宇名称 Name of Building/House
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屋苑/屋村名称 Name of Estate
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街道 Street Name
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街道号码 Street No.
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地区 District
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香港以外国家 Country Outside HK
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* 为必须输入资料 Required data input |
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信用卡号码 Card No. *
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到期日 (MM/YY) Expiry Date *
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定额捐款到期日 Expiry date of regular donation
[ 如 阁下意欲本交易指示无限期有效 (或直至 阁下予以撤销为止),则请将该栏留空。]
[If you wish this instruction to have effect indefinitely (or until cancelled by you), please leave the field blank. ]
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1. 本人现授权香港圣公会福利协会有限公司由本人之信用卡账户内定期扣除上述之款项,直至上述之定额捐款到期日或另行通知为止。(以两者中最早之日期为准。)
I/We hereby authorize Hong Kong Sheng Kung Hui Welfare Council Limited to charge my card account for the relevant amounts specified above. The Authorisation shall have effect until the given expiry date of regular donation or further notice. (whichever shall first occur.)
2. 在本人进行定额捐款期间,本人同意此授权书於本人之信用卡有效期后及获续发新卡时继续生效,并无须另行填写通知书。如须取消或更改本授权书,需於取消或更改生效日期最少7 个工作天前以书面通知香港圣公会福利协会有限公司。
I/We agree that this Authorisation shall have effect after the expiry date of the credit card and the issue of the replacement card, and no renewed Authorisation form will be required when the regular donation is effective. I/We agree that any written notice of cancellation or variation of this Authorisation shall be given at least 7 working days before such cancellation/variation is to take effect.
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登入名为输入电邮 :
未输入电邮
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请在於下栏加上‘✔’号。 Please indicate by putting a tick '✔' in the box below:
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# 必须在空格内加上「✔」 # please put a "✔" in the box |
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多谢! Thank you!
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