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 *
|
捐款金額 Donation Amount *
|
是否需要捐款收據? Receipt Required? *
|
稱呼 Salutation
|
捐款者類別 Donor Categories *
|
善長芳名 Name of Donor *
|
電郵 Email *
|
性別 Gender
|
年齡 Age
|
聯絡電話 Telephone No. *
|
手提電話 Mobile Phone No.
|
傳真 Fax No.
|
室 Flat/Room
|
樓 Floor
|
座 Block
|
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
|
香港以外國家 Country Outside HK
|
* 為必須輸入資料 Required data input |
|
信用卡號碼 Card No. *
|
到期日 (MM/YY) Expiry Date *
|
定額捐款到期日 Expiry date of regular donation
[ 如 閣下意欲本交易指示無限期有效 (或直至 閣下予以撤銷為止),則請將該欄留空。]
[If you wish this instruction to have effect indefinitely (or until cancelled by you), please leave the field blank. ]
|
|
1. 本人現授權香港聖公會福利協會有限公司由本人之信用卡賬戶內定期扣除上述之款項,直至上述之定額捐款到期日或另行通知為止。(以兩者中最早之日期為準。)
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. 在本人進行定額捐款期間,本人同意此授權書於本人之信用卡有效期後及獲續發新卡時繼續生效,並無須另行填寫通知書。如須取消或更改本授權書,需於取消或更改生效日期最少7 個工作天前以書面通知香港聖公會福利協會有限公司。
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.
|
|
登入名為輸入電郵 :
未輸入電郵
|
|
|
|
請在於下欄加上‘✔’號。 Please indicate by putting a tick '✔' in the box below:
|
|
# 必須在空格內加上「✔」 # please put a "✔" in the box |
|
多謝! Thank you!
|
|