仁愛堂每月捐款表格 Yan Oi Tong Monthly Donation Form If you are human, leave this field blank. 仁愛堂每月捐款表格 Yan Oi Tong Monthly Donation Form 本人樂意每月捐款支持仁愛堂。 I would like to make monthly donation to support Yan Oi Tong. 捐款用途 Donation Purpose： * 一般捐款（仁愛堂綜合服務）General Donation 仁愛堂社會服務 Yan Oi Tong Social Services 仁愛堂教育服務 Yan Oi Tong Educational Services 仁愛堂醫療服務 Yan Oi Tong Medical Services 仁愛堂「樂助弱老」基金 Yan Oi Tong Elderly Care Fund 仁愛堂「仁間有愛」支援計劃 Yan Oi Tong “Love and Care” Project 仁愛堂長者愛心卡計劃 Yan Oi Tong Love Elderly Card Scheme 仁愛堂陽光加油站計劃 Yan Oi Tong Sunshine Program 仁愛堂蔡黃玲玲教育基金 Yan Oi Tong Choi Wong Ling Ling Education Fund 仁愛堂莊舜而醫療基金（治療癌症）Yan Oi Tong Chong Sok Un Medical Fund (Cancer Aid) 仁愛堂史立德夫人青少年兒童醫療基金 Yan Oi Tong Mrs. Shi Lop Tak Youth & Children Medical Foundation 仁愛堂羅台秦關愛基金（精神健康） Yan Oi Tong Lo Tai Chin Caring Foundation (Mental Health) 認知障礙症支援服務 Cognitive Impairment Support Services 仁愛堂鄭丁港善心藥物中心 Yan Oi Tong Cheng Ting Kong Charity Drug Center 「醫者仁心」贈醫施藥計劃 Free Consultation and Medicine Scheme 其他 Others（請註明）： 其他 Others（請註明）： 捐款金額 Donation Amount： * HK$1000 HK$500 HK$200 其他：HK$ 其他：HK$ 信用卡資料 Credit Card Details （本堂將於每月安排信用卡自動轉帳，如欲使用銀行戶口自動轉帳，需由善長向相關銀行查詢及安排 Auto-pay via credit card will be arranged by Yan Oi Tong every month. If you would like to arrange auto-pay transaction from your bank account, please contact your bank for details.） 信用卡 Credit Card： * Visa Master 信用卡號碼 Card no.： * 有效日期 Expiry Date (MM/YY)： * 持卡人姓名 Cardholder’s Name： * 善長資料 Donor’s Details 中文姓名 Chinese Name： 稱謂： 先生 小姐 女士 太太 英文姓名 English Name： * Title： Mr Miss Ms Mrs （用作捐款收據抬頭 Your name will be printed on donation receipts） 地址 Address： * 電話 Tel： * 電郵 Email： * 本人現授權仁愛堂由本人上述信用卡帳戶每月扣除上述指定金額，直至另行通知。I hereby authorize Yan Oi Tong to debit the monthly donatio from my credit card account unless further notice is given to Yan Oi Tong. * 本人現授權仁愛堂由本人上述信用卡帳戶每月扣除上述指定金額，直至另行通知。I hereby authorize Yan Oi Tong to debit the monthly donation from my credit card account unless further notice is given to Yan Oi Tong. 請開發捐款收據（只適用於港幣100元或以上之捐款，本堂將於每年4月按捐款總額開發捐款收據）Please send me a summarized donation receipt in April every year for all of my donations 請開發捐款收據（只適用於港幣100元或以上之捐款，本堂將於每年4月按捐款總額開發捐款收據）Please send me a summarized donation receipt in April every year for all of my donations 多謝您的慷慨捐助！您的一分一毫，能讓更多有需要人士受惠。 Thank you for your generous support. Your donation could make a difference for the under-privileged people. 本人現授權仁愛堂由本人上述之信用卡賬戶內扣除指定金額作定期捐款，並同意授權在本人上述之信用卡有效期後及獲續發新卡時繼續生效，直至另行通知。如需取消或更改本授權書，請於生效日期十個工作天前通知仁愛堂。 I hereby authorize Yan Oi Tong to charge my card credit account for the relevant amounts specified above. I agree that this authorization shall have effect after the valid date of the credit card or replacement of the credit cards. This authorization shall have effect until further notice. I agree that any notice of cancellation or variation of this authorization shall be given at 10 working days before such cancellation/variation is to take effect. 按此提交捐款表格
