捐款詳情 Donation Details

單次捐款 One-off Donation

由 From

至 To

另行通知為止 Until further notice

捐款金額 Donation Amount

HKD 100

HKD 200

HKD 500

HKD 1,000

其他金額 Other Amount

HKD

捐款目的 Designated Use / Department

善款會用於一般病人服務。如有指定用途，請註明：
The donation will support general patients' services unless otherwise specified.

捐款方式 Donation Method

八達通 Octopus

請使用手機掃描以下二維碼，透過八達通手機應用程式進行捐款。
Please scan the QR code below with your mobile phone, and make donation via Octopus App.

請於成功捐款後，上載交易截圖（須顯示付款日期），並填妥以下表格。
Please upload the screenshot of your online payment record (with payment date) after successful transaction and complete the form below.

*請留意系統僅接納特定檔案格式，包括圖像例如JPEG，PNG，GIF，TIFF, BMP以及PDF。檔案大小上限為 3MB。
*Please be reminded that only specific file formats are accepted, including images such as JPEG，PNG，GIF，TIFF, BMP and PDF. The file size limit is 3MB.

選擇檔案
Select Files

PayMe

請使用手機前往 (PayLink) 或掃描以下二維碼，透過PayMe手機應用程式進行捐款。
Please visit (PayLink) or scan the QR code below with your mobile phone, and make donation via PayMe App.

選擇檔案
Select Files

網上捐款 PayPal

請填妥並提交以下表格，再透過網上支付系統使用信用卡（Visa, Master Card, American Express, Discover） / 扣賬卡 / PayPal帳戶進行捐款。
Please complete and submit the following form, then make donation online through credit card (Visa, Master Card, American Express Discover) / debit card / PayPal account.

注意事項：

信用卡 / 扣賬卡資料的更改，有機會導致轉賬未能成功。如該次未能成功過數，基金秘書處將與捐款者聯絡及在其同意下再安排一次過數。
Any changes of the credit card / debit card information may lead to failure of transaction. Should the transaction fail, the Secretariat of the Trust will contact the donor and make a second attempt at donor’s consent.

銀行存款 / 銀行轉賬 / 轉數快 Bank Deposit / Bank Transfer / FPS

閣下可將善款存入以下銀行，並於成功捐款後，上載付款收據或交易截圖（須顯示付款日期），並填妥以下表格。
You can deposit the donation into the following bank. After successful transaction, please upload bank transfer copies or the screenshot of your online payment record (with payment date) and complete the form below.

銀行帳戶詳情 Bank Account details

銀行 Bank：
東亞銀行 Bank of East Asia （銀行編號 Bank Code：015）

帳戶號碼 Bank Account Number：
015-518-25-01293-2
帳戶名稱 Bank Account Name：

善心醫療基金 NTWC Charitable Trust

選擇檔案
Select Files

捐款人資料 Donor Particulars

個人名義捐款 Individual Donor

機構名義捐款 Corporate Donor

匿名名義捐款 Anonymous Donor

捐款人稱謂 Title of Donor*

捐款人姓名 Name of Donor*

聯絡人稱謂 Title of Contact

聯絡人姓名 Name of Contact

捐款機構名稱 Name of Organisation*

聯絡人稱謂 Title of Contact*

聯絡人姓名 Name of Contact*

稱謂 Title

姓名 Name

捐款收據 Receipt

捐款可獲發收據，港幣一百元或以上可作扣稅用途。捐款收據將根據下列選項以個人芳名或機構名稱發出。
如需以郵寄方式收取收據正本，請於下方提供通訊地址。
Donation receipt will be issued for donation of HK$100 or above which is tax-deductible. The donation receipt will be issued to the name of individual or organization according to option chosen below.
For receiving the original receipt by post, please also provide the correspondence address.

不需要 Not Required

經郵寄 By Post

經電郵 By E-mail

感謝信 Thank You Letter

捐款可獲發感謝信。感謝信將根據下列選項方式發出。
如需以郵寄方式收取感謝信，請於下方提供通訊地址。
Thank you letter will be issued for donation. The thank you letter will be issued according to option chosen below.
For receiving the thank you letter by post, please also provide the correspondence address.

不需要 Not Required

經郵寄 By Post

經電郵 By E-mail

地址 Address*

電話 Telephone*

傳真 Fax

電郵 E-mail*

授權使用個人資料
Authorisation for the Use of Personal Data

個人資料收集聲明 Personal Information Collection Statement *

本表格所收集閣下的個人資料將嚴格保密處理，並只會向善心醫療基金（下稱「基金」）及醫院管理局新界西醫院聯網（下稱「新界西聯網」）提供，以用作與籌募相關事宜及發出收據的目的。
Your personal data collected in this form will be kept strictly confidential and made available only The Hospital Authority New Territories West Cluster Hospitals Charitable Trust (“the Trust”) and New Territories West Cluster of the Hospital Authority (“NTWC”) to use for purposes relating to donation matters and for issuing receipts.

使用個人資料作籌募推廣 Use of Personal Data for Solicitation of Donations

根據《個人資料（私隱）條例》，由於基金及新界西聯網擬使用閣下的個人資料（即你的姓名和聯絡資料）進行慈善募捐，我們需先取得閣下的同意，但基金及新界西聯網在未得到你的同意之前不會如此使用你的個人資料。
如閣下願意繼續支持基金及新界西聯網的慈善工作，並同意我們使用你的個人資料為基金及新界西聯網進行慈善募捐，請於左方空格加上「✓」。
你有權隨時查閱和改正基金及新界西聯網持有關於你的個人資料。如要行使上述權利或不欲再收到基金及新界西聯網有關慈善募捐的推廣資訊，請致電2468 5464 或電郵至ntwc.charitabletrust@ha.org.hk與本基金秘書處聯絡。

Under the Personal Data (Privacy) Ordinance, the Trust and NTWC 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 the Trust and NTWC but will not so use your personal data unless your consent is received.
Please check the box if you agree to support the charity work of the Trust and NTWC and the use of your personal data for solicitation of donations to the Trust and NTWC.
You have rights of access and correction with respect to your personal data held by the Trust and NTWC. If you wish to exercise these rights or you do not wish to receive any promotional materials on solicitation for donations to the Trust and NTWC afterwards, please contact the Secretariat of the Trust at 2468 5464 or by email ntwc.charitabletrust@ha.org.hk.

在提交捐款表格前，請先核對以下資料。
Please confirm below details before proceeding to submission.

捐款資料詳情Summary of donation information

捐款詳情Donation Details

捐款金額Donation Amount

捐款目的Designated Use / Department

捐款方式Donation Method

捐款人資料Donor Particulars

捐款人稱謂
Title of Donor

捐款人姓名
Name of Donor

聯絡人稱謂
Title of Contact

聯絡人姓名
Name of Contact

捐款機構名稱
Name of Organisation

聯絡人稱謂
Title of Contact

聯絡人姓名
Name of Contact

稱謂
Title

姓名
Name

地址
Address

電話
Telephone

傳真 Fax

電郵
E-mail

感謝信Thank You Letter

捐款收據Receipt

授權使用個人資料Authorisation for the Use of Personal Data

我授權善心醫療基金及醫管局收集及使用我的個人資料為善心醫療基金及醫管局進行慈善募捐。

I to give my consent to The Hospital Authority New Territories West Cluster Hospitals Charitable Trust (“the Trust”) and Hospital Authority (HA) to collect and use my personal data for solicitation of donations to the Trust and HA.

捐款詳情 Donation Details

捐款金額 Donation Amount

捐款目的 Designated Use / Department

捐款方式 Donation Method

捐款人資料 Donor Particulars

捐款收據 Receipt

感謝信 Thank You Letter

授權使用個人資料 Authorisation for the Use of Personal Data

捐款資料詳情Summary of donation information

秘書處 Secretariat

授權使用個人資料
Authorisation for the Use of Personal Data