Online Donation

Designated Beneficiaries

Hospital

Department / Unit : (Please specify)

Donation Purpose

Medical Equipment & Supplies

Staff Training & Development

Service Improvement

Others (e.g. Patient Support & Welfare, etc.), please specify

Type of Donation

One-off Donation

Recurring Donation

Specified-period Donation

Donation Amount

HK$10,000

HK$5,000

HK$1,000

HK$500

HK$200

Other amount: HK$

Donation period

Yearly

Monthly

Number of cycles :

(1 - 999)

Donor Particulars

Individual Donor

Corporate Donor

Name of Donor : *

Anonymous

Contact Person : *

Same as donor

Different from donor

Name of Organization : *

Name of Contact Person : *

Position of Contact Person : *

Telephone Number :

(For enquiry on this donation if needed)

Address :

(If a physical receipt is required)

Email :

(If a receipt via email is required)

Fax :

Notes to PYNEH :

Receipt

Donation receipt will be issued for donation, of which HK$100 or above is tax-deductible. The donation receipt will be issued to the name of individual or organization according to option chosen below.

Receipt is not required

By post

By email

Name on receipt : *

Same as donor

Same as contact person

Others (Please specify) :

Others

I agree to have my donation / donation of the organization acknowledged by PYNEH.

Authorization for the Use of Personal Data for Direct Marketing.

Personal Information Collection Statement

Your personal data collected will be kept strictly confidential and made available only to PYNEH, The PYNEH Charitable Trust and HA to use for purposes relating to donation matters and for issuing receipts.

Under the Personal Data (Privacy) Ordinance, PYNEH, The PYNEH Charitable Trust and HA need to obtain your consent as we intend to use your personal data (i.e. your name and contact data) for solicitation of donations for charitable purposes to PYNEH, The PYNEH Charitable Trust and HA but will not so use your personal data unless your consent is received.

Use of Personal Data for Solicitation of Donations

You understood that by checking this box, you agree to support the charity work of PYNEH, The PYNEH Charitable Trust and HA and the use of your personal data for solicitation of donations to PYNEH, The PYNEH Charitable Trust and HA.

You have rights of access and correction with respect to your personal data held by PYNEH, The PYNEH Charitable Trust and HA. If you wish to exercise these rights or you do not wish to receive any promotional materials on solicitation for donations to PYNEH, The PYNEH Charitable Trust and HA afterwards, please contact Finance Services Division of PYNEH at 2595-6877 or by email pyneh_dmo@ha.org.hk.