CHARITY BIKE ‘N’ BLADE 2015 – FUNDRAISING DONATION FORM 

Individual Donation

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Corporate Donation

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My/our donation is made in support of a Charity Bike ‘N’ Blade participant: (Please specify name as in registration form): ____________________________________________________

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My/our donation is made in support of Charity Bike ‘N’ Blade (no particular participant).

Donation Details: My/our donation amount is: S$____________________________________________________________________ 

Enclosed is my/our cheque made payable to “St. Andrew’s Community Hospital”.

Bank: ________________________________ Cheque Number: ______________________________ 

Please charge my/our donation to: * VISA / MASTERCARD / AMEX / DINERS (*Please circle) Name on Card: __________________________________________________________________________ Credit Card Number: _____________________________________________________________________ CVV Number (CVV Number is the last 3/4 digits printed at the back of your credit card): _____________________

Bank: ________________________________ Expiry Date (MM/YYYY): _________________________ Signature: ____________________________ My Particulars: Name: (as in NRIC / Passport / Registered Company)

* Dr / Mr / Ms / Mdm / Mrs (*Please circle)

NRIC / FIN:

Contact No.:

Company:

UEN:

Address: Postal Code:

Email:

Please mail completed forms and cheques (if any) to: St. Andrew's Community Hospital, Corporate Communications Department, 8 Simei Street 3, Singapore 529895 All donations will be to St. Andrew’s Community Hospital and The Salvation Army - Peacehaven Nursing Home. Tax deduction will be accorded to donations of S$50 and above. Donations will receive 3 times tax deduction and be automatically included in your tax assessment if you have provided your Tax Reference number (eg. NRIC/FIN/UEN). Tax-deductible receipts (either by St. Andrew’s Mission Hospital or The Salvation Army Peacehaven Nursing Home) will be sent to you by 30 November 2015. * St. Andrew’s Community Hospital and The Salvation Army respect donors’ confidentiality. By submitting this donation form, you consent to the use of your personal data for processing donations, donor relationship management, fundraising and communications.  Please tick if you do not wish to receive communication materials for our donors.