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Donation Mode

Donation Through *

Donation Frequency *

Donation Details

Donation Amount *

S$ 58: Provides a patient a return trip with home-hospital transportation

S$ 118: Provides a patient with 2 weeks supply of adult diapers

S$ 228: Provides a hospice patient with 2 weeks supply of milk

Others

Donation Amount *

S$ 58: Provides a patient a return trip with home-hospital transportation

S$ 118: Provides a patient with 2 weeks supply of adult diapers

S$ 228: Provides a hospice patient with 2 weeks supply of milk

Others

Other Amount (Please Indicate) *

Please enter a minimum donation amount of $5

Donation Details

Cheque Number *

Issuing Bank *

Donation Amount *

Please enter a minimum donation amount of $5

Donation Details

Name as in Bank’s Record *

Account Number *

Name of Bank *

Bank Branch

Donation Amount *

S$ 58: Provides a patient a return trip with home-hospital transportation

S$ 118: Provides a patient with 2 weeks supply of adult diapers

S$ 228: Provides a hospice patient with 2 weeks supply of milk

Others

Other Amount (Please Indicate) *

Please enter a minimum donation amount of $5

Personal Particulars

ID Type *

UEN *

Company Name *

NRIC / FIN / Passport *

Salutation *

Other Salutation *

Given Name *

Middle Name

Last Name *

Gender *

Male

Female

You must provide a value for Gender

Date of Birth (DD/MM/YYYY) *

Designation

Employer / Institution

NRIC Address Details

Address Type *

Postal Code *

Unit Number

Street

Building Name

Country *

Home Phone

Mobile Phone *

Office Number

Fax Number

Email *

Please “TICK” if the above address is different from mailing address.

Mailing Address Details

Address Type *

Postal Code *

Unit Number

Street

Building Name

Country *

PDPA *

I consent to allow Singapore Cancer Society (“SCS”) to collect, use, disclose and/or process my personal data in order to process, administer, facilitate, maintain and/or manage my relationship with SCS as a member, volunteer, programme participant, beneficiary and/or donor (“Purpose”), including communications on SCS’ activities, programs and services; donation requests; carrying out research, analysis and development activities for SCS’ purposes; and making disclosures required by law or a competent authority. SCS may, for the above Purpose, disclose my personal data to its third party service providers and/or agents, which may be sited outside of Singapore (subject always to requirements under applicable law having been met*).

If you wish to receive communications on SCS’ activities, programs and services via phone call and/or text message to a phone number or numbers that you have provided to SCS, please TICK the relevant box(es):

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Phone Call

In any event, you agree that SCS may send communications on its activities, programs and services to you via email and/or post.

If you do not wish to receive such communications via email and/or post, or if you wish to make changes to consent previously given, you understand that you may opt-out by writing to the “SCS Data Protection Officer” at “Singapore Cancer Society, 30 Hospital Boulevard, #16-02 NCCS Building, Singapore 168583” or to the following email address dataprotection@singaporecancersociety.org.sg

* Your kind contribution to Singapore Cancer Society is greatly appreciated and we would like to acknowledge your support in our publications. Please indicate your preference to be acknowledged. Yes No

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