Changes on Monthly Donation Form

Please fill in the information in English * Required

I would like to change my monthly donation:

Donation method

Monthly Payment

Donation by

Personal Donation

Donation Amount

$178 to help one recipient use the "Care-on-Call Wireless PEL” service for free 1 month.

$198 to help one recipient use the “Safety Phone” service for free 1 month.

$376 to help two-senior family use the "Care-on-Call Wireless PEL” service and “Safety Phone” service for free 1 month.

$752 to help two two-senior families use the "Care-on-Call Wireless PEL” service and “Safety Phone” service for free 1 month.

Other amount, please specify

Other Amount

Donation Amount

$400 can help 1 recipient use the escort service for free once a month

$520 can help 1 recipient use the elderly care service for free once a month

$560 can help 1 recipient use the home cleaning service for free once a month

Other amount, please specify

Other Amount

Other monthly donation method

Bank Transfer	Download and print donation form, and mail the original copy of the completed donation form to " Fundraising & Charity Dept, Senior Citizen Home Safety Association, S2, 2/F, Oi Man Plaza, Homantin, Kowloon, Hong Kong".

Donor Information

Chinese Name

English Name*

Donor Code (if applicable)

Donor Enterprise (if applicable)

Date of Birth*

Contact Information

Contact Number*

Email Address

Address (Must be filled in if donation receipt is required)

Do you need a receipt*

Yes

If the recipient of the receipt is not the donor, please fill in the name of the recipient

Credit Card's Information

VISA

Master Card

Credit Card Number*

Expiry Date (MM/YY)*

Name of Card Holder*

Receipt arrangement

Donations of HK$100 or above are tax deductible. Donation receipts will be issued in early-April each year to summarise your entire year of donations.

Credit Card Monthly Donations Considerations

I hereby authorize the Senior Citizen Home Safety Association ('SCHSA') to periodically debit the above amount from my credit card account. This authorization will continue to take effect after the validity period of my credit card and after the issuance of a new card until further notice. Variation or cancellation on this authorisation shall be given to the Fundraising & Charity Department of SCHSA at 2952 7330 during working hours for 10 working days before the date on which such variation or cancellation to take effect. The credit card payment date is the 16th of each month. Credit card transactions that are unsuccessful on 16th will be processed again on the 25th of the month. All donaiton transactions will take place on the next working day in case of public holiday.

Personal Data Collection Statement

Senior Citizen Home Safety Association ('SCHSA') complies with the requirements set out in the Personal Data (Privacy) Ordinance (Ordinance) to safeguard the interests of data subjects, including ensuring that personal data stored is accurate and properly stored. SCHSA will use your personal data (including your name, telephone, fax, email and mailing address) for SCHSA to send future newsletters and reports on fundraising activities, club information, issue receipts and to contact you about donations. You can ask SCHSA to stop using your personal data for the above purposes and to update your personal data at any time by calling 2952 7330.

I do not consent to the use of my personal data by the Senior Citizen Home Safety Association for the above purposes