捐款額 Donation Amount (Recepits will be issued for all donations) HK$: 捐款人或捐款公司資料 Your Personal or Company Details 個人/公司英文名稱 Name in English : 個人/公司中文名稱 Name in Chinese: 聯絡人姓名 Name of Contact Person : 通訊地址 Correspondence Address : 收據名稱 Name to appear on receipt: 辦公室總機電話 Tel : 聯絡電郵地址 Email : 以支票捐款 By Cheque (抬頭請寫"Med-Art Limited" / Please enclose a crossed cheque payable to "Med-Art Limited" ) 捐款數目 Amount of Donation : 支票號碼 Cheque : 以銀行電匯轉賬 By Telegraphic Transfer (轉賬時請註明"醫藝盟慈善捐款") (When making a telegraphic tranfer, please quote "Med-Art Donation" to facilitiate our administration.) 電匯銀行名稱 Name of your Bank : 電匯日期 Date of TT : 捐款數目 Amount of Donation : 港幣存款銀行賬戶資料 Bank Account Details : 賬戶名稱 Account Name : Med-Art Limited 銀行名稱 Bank : Hongkong and Shanghai Banking Corporation Limited 賬戶號碼 Account No. : 004-808-289052-001 *Contact [email protected] wire tranfer instructions. 備註:以上資料只會用作發收據及慕捐用途。 All personal data and other information disclosed in this form is subject to the Privacy Policy of Med-Art Limited, which may be download from its website. www.medart.org.hk, and is also available on written request to : The Data Privacy Officer, Med-Art Limited, China Orphan Outreach Program, Limited, China Orphan Outreach Program, Suite 631, Central Building, Pedder Street, Central, Hong Kong. Med-Art Limited has been approved by the Inland Revenue Department of Hong Kong as a charitable institution of a public character that is exempt from taxation under section 88, Inland Revenue Ordinance. Donations to Med-Art Limited will qualify for deduction from taxable income in repect of tax liabilities in Hong Kong, subject to applicable laws. Med-Art Limited Suite 631, Central Building, Pedder Street, Centra, Hong Kong Tel: +852 3549-6930 Fax: +852 3105-9920 [email protected] www.medart.org.hk .