Seal here, do not staple.
PERSONALPARTICULARS
Name (Dr / Mr / Ms / Mrs / Mdm / Company)*
NRIC / FINNo / UEN*
Tel (Mobile)
Address
Postal Code
(Office)
Email
I would like tohelpCCF fund its on-goingprogrammes and services to childrenwith cancer by:
RecurringmonthlyGIRO contribution of $___________________________ (Please complete InterbankGIROApplication Form)
IncreasingmymonthlyGIRO contribution to $ _______________________
Aone-time contribution of $ _______________________byCheque / Postal Order / MoneyOrder No.* _______________________
(All chequesshouldbemadepayable to “Children’sCancerFoundation”)
Monthly / one-time* contribution of $_______________________by VISA / Master Card
*
Asingle donation of S$50 and above toCCFwill be eligible for IRAS tax deduction of 2.5 times the donated amount in 2016.
*
Pleasewrite your NRIC/FIN/UEN number clearly.
*
Wewill automatically include your donation in your tax assessment by IRAS. As such, wewill not issue a separate receipt for your donation.
*
Thepurposes for whichCCFwill collect, useanddisclose your personal data includebut arenot limited to verifying your identity; registering your donationand tax referencenumber
with IRAS in order to qualify you for a tax deduction (if applicable); administrativematters on donation payments or refunds.
By checking this box, I consent to the use of my personal data provided in this GIRO Form by CCF for the specified purposes of sendingme CCF announcements and
any other communications onmatters pertaining toCCF-related programmes, events and services.
* Please deletewhere inapplicable
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-
-
CVV2
Expiry
Date
Signature /
Date
INTERBANKGIROAPPLICATIONFORM
PART 1: FORAPPLICANT’SCOMPLETION
(Please fill in all fields unless otherwise stated. Incomplete formsmay not be processed)
Date
ToMy / Our Bank (“Bank”)
(As in Finance Institution’s records)
* For thumbprint(s), please go to the branchwith your identification document
Name of BillingOrganisation ("BO")
Expiry date of this authorisation (If applicable)
Children’sCancer Foundation
Payment limit (Maximum amount to be deducted per transaction)
Branch
My / Our Name(s)
My / OurAccount Number
Name of Approving
My / Our Contact Number(s)
My / Our Company Stamp / Signature(s) / Thumbprint(s)*
(Tel)
(Fax)
ThisApplication is herebyREJECTED (Please tick
) for the following reason(s):
PART 2: FORBILLINGORGANISATION’SCOMPLETION
PART 3: FORFINANCIAL INSTITUTION’SCOMPLETION
SWIFT BIC
Billing Organisation’sAccount No
(UOVBSGSG) 001
BillingOrganisation’sCustomer Ref No
SWIFT BIC
Account No. To beDebited
To: CCFCommunityOffice
8SinaranDrive #03-01
NovenaSpecialist Centre
Singapore 307470
Signature/thumbprint* differs fromFinancial Institution’s records
Signature/thumbprint* incomplete/unclear*
Account operated by signature/thumbprint*
WrongAccount Number
Amendments not countersigned by customer
Others ______________________________
Seal here, do not staple.
Authorised
Date
* Please deletewhere inapplicable
(a) I/We hereby instruct theBank to process theBO’s instructions to debit my/our account.
(b) TheBank is entitled to reject theBO’s debit instruction ifmy/our account does not have sufficient funds and chargeme/us a fee for this. TheBankmay alsoat its discretionallow the
debit even if this results in an overdraft on the account and impose charges accordingly.
(c) This authorisationwill remain in force until
(i) theBank’swritten notice sent tomy/our address last known to theBank;
(ii) upon theBank’s receipt of my/our written revocation; or
(iii) upon theBank’s receipt of the notice of expiry from theBO.
(d) If youwish to cancel / alter your GIRO Instructions, please notifyChildren’sCancer Foundation inwriting or email to
