本人願意捐款作以下用途 I would like to donate for the following purpose(s)
捐款用途 Donation Designation *
一般捐款 General Donation
基層兒童 Children Living in Subsistence Level
青少年及家庭服務 Youth and Family Services
扶貧及食物援助 Poverty and Food Assistance
喪親家屬支援服務 Bereavement Support Services
特殊學習需要服務 Special Educational Needs Services
安老服務 Elderly Services
復康服務 Rehabilitation Services
中風復康慈惠基金 Stroke Rehabilitation Charity Fund
醫療康健服務 Medical and Wellness Services
其他 (如希望捐款予指定用途,請註明) Other (please specify if you wish to donate for specified items/projects)
捐款金額 Donation Amount *
是否需要捐款收據? Receipt Required? *
稱呼 Salutation
先生 Mr
小姐 Miss
女士 Ms
博士 Dr
牧師 Revd
傳道 Pastor
不適用 N/A
捐款者類別 Donor Categories *
善長芳名 Name of Donor *
電郵 Email *
性別 Gender
Male
Female
年齡 Age
聯絡電話 Telephone No. *
手提電話 Mobile Phone No.
傳真 Fax No.
室 Flat/Room
Flat
Room
Unit
Suite
No
Shop No.
Apt
室
座
號
號鋪
樓 Floor
座 Block
Block
Tower
Phase
House
Stage
座
期
號屋
大廈/樓宇名稱 Name of Building/House
屋苑/屋村名稱 Name of Estate
街道 Street Name
街道號碼 Street No.
地區 District
Hong Kong Island
Sheung Wan
Tai Hang
The Peak
Central
Soho
Lan Kwai Fong
Tin Hau
Tai Koo
North Point
Mid Levels
Shek O
West Central
Stanley
Admiralty
Chai Wan
Wan chai
Sai Wan Ho
Xing hua cun
Aberdeen
Repulse Bay
Deep Water Bay
Happy Valley
Shau Kei Wan
Causeway Bay
Pok Fu Lam
Cyberport
Wong Chuk Hang
Quarry Bay
Shek Tong Tsui
Sai Ying Pun
Kennedy Town
Ap Lei Chau
Kowloon
Prince
Jordan
Mong Kok
Yau Tong
Hung Hom
Mei Foo
Choi Hung
Lok Fu
Lam Tin
Kwun Tong
Kowloon City
Kowloon Tong
Kowloon Bay
To Kwa Wan
Tai Kok Tsui
Ngau Tau Kok
Shek Kip Mei
Tsim Sha Tsui
Knutsford Terrace
He Men tin
Yau Ma Tei
Chang Sha Wan
Lai Chi Kok
Wong Tai Sin
Tsz Wan Shan
San Po Kong
Lei yue Mun
Diamond Hill
Sham Shui Po
New Territories
Sheung Shui
Tai Po
Tai Wai
Yuen Long
Tai Wo
Tuen Mun
Fo Tan
Sai Kung
Shatin
Tsing Yi
Fanling
Tsuen Wan
Ma Wan
Sham Tseng
Kwai Fong
Kwai Chung
Lo Wu
Tin Shui Wai
Lau Fau Shan
Ma On shan
Tseung Kwan O
Lok Ma Chau
Islands
Tai O
Peng Chau
Tung Chung
Cheung Chau
Lantau Island
Lamma Island
Discovery Bay
Po Toi Island
香港以外國家 Country Outside HK
United Arab Emirates
Australia
Brazil
Canada
Switzerland
Chile
China
Czech Republic
Germany
Ecuador
United Kingdom
Spain
France
Sri Lanka
Indonesia
Ireland
India
Italy
Japan
South Korea
Macau
Mexico
Malaysia
Netherlands
New Zealand
Poland
Russia
Singapore
Slovakia
Thailand
Turkey
Taiwan
United States
South Africa
* 為必須輸入資料 Required data input
信用卡號碼 Card No. *
到期日 (MM/YY) Expiry Date *
安全碼 Security Code *
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請於下欄加上‘✔’號。 Please indicate by putting a tick '✔' in the box below:
我同意福利協會將我的個人資料作上述第6段所述用途。 I agree to the use of my personal data by the Welfare Council for the purposes set out in Clause 6 above.
我不同意福利協會將我的個人資料作上述第6段所述用途。 I do not agree to the use of my personal data by the Welfare Council for the purposes set out in Clause 6 above.
不願意收取電郵資料 Prefer not to receive e-publications
# 必須在空格內加上「✔」 # please put a "✔" in the box
多謝! Thank you!
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