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1、 我們樂意支持 親切親切 I would like to support TREATS DONATION AMOUNT 捐款金額捐款金額 HK$5000 HK$3000 HK$2000 HK$1500 HK$ My Details 個人資料個人資料(Please write in BLOCK Letters 請以英文正楷填寫) Company Name 公司名稱： English 中文Contact Person Name in English : 中文姓名： Mobile No. Home Tel. 手提電話： 住宅電話：Office Tel. Fax No. 辦公室電話： 傳真：E-mai
2、l 電郵：Address 地址：_ Direct Debit Authorization Form 自動轉賬授權書自動轉賬授權書 Name of party to be credited (The Beneficiary) 收款之一方受益人 T R E A T S 親親 切切Bank no. Branch no. Account No. to be credited 銀行媥號 分行編號 收款帳戶之號碼0 0 4 1 1 1 1 5 8 3 8 2 0 0 1 1. My/our full names(s) with my/our Bank 本人/吾等之銀行戶口姓名 Mr/Ms/Miss 先生/
3、女士/小姐 2. Bank and Branch Name銀行及分行名稱3. Bank No. Branch No. Savings / Current Account No.銀行編號 分行編號 本人/吾等之儲蓄/來往戶口號碼4. HKID No. 香港身份證號碼 We would like to join TREATS services, please contact me. 本公司希望參與親切義工服務，請與我聯絡。D O N A T I O N M E T H O D 捐捐 款款 方方 法法 Credit Card 信用卡信用卡 VISA Card MASTER Card JCB Cred
4、it Card Issuing Bank 信用卡簽發銀行：Credit Card Number信用卡號碼：Cardholders Name 信用卡持有人姓名：Card Expiry Date MM/ YY (Should be valid for the next 3months)信用卡有效日期至： 月 年 (三個月內有效)Cardholders signature Date 信用卡持有人簽名 日期 NOTE *Please ensure that you sign the form as well as any alterations in the same way as you sign
5、your credit card account. 簽名必需與閣下之信用卡簽名完全相同，表格上如有任何塗改，請在旁加簽。 Your personal data will be kept confidential. 您的個人資料將會絕對保密！您的個人資料將會絕對保密！ The above information will be used for issuing receipt, fostering communications, raising funds and conducting donor survey for TREATS. 親切親切將運用你的個人資料發出收據、通訊、籌募本會經費及收集
6、意見之用途。 Please notify us in writing if you do not wish to receive future mailings from TREATS. 若閣下不希望收到本會之通訊，請來函通知。 Cheque 支票支票 (支票號碼支票號碼 No: ) 支票抬頭請寫上親切. Crossed cheque please made payable to TREATS Direct Payment 直接捐款直接捐款 恆生銀行（恆生銀行（024-388-806283-002） 請將存款收據正本正本連同表格寄回 Please send the original bank
7、pay-in-slip together with this form to us.5 . My/our signature(s) 本人/吾等之簽名在結單/存摺上所記錄之簽名 日期Sign your name as recorded on statement/passbook Date 1.I/we hereby authorize my/our below-named Bank to effect transfer from my/our account to that of TREATS (named of beneficiary) in accordance with such inst
8、ructions as my/our Bank may receive from the beneficiary from time to time provided always that the amount of any one such transfer should not exceed the limit indicated below. 2.I/we agree that my/our Bank shall not be obliged to ascertain whether or not notice of any such transfer has been given t
9、o me/us. 3.I/we jointly and severally accept full responsibility for any overdraft (or increase in existing overdraft) on my/our account which may arise as a result of any such transfer(s). 4.I/we confirm that my/our signature(s) on this application form is/are the same as that/those for the operati
10、on of my/our Savings/Current Account to be debited for the transfer. 5.This authorization shall have effect until further notice. 6.I/we agree to notify TREATS (name of beneficiary) of any change of bank account or cancellation of payment method and further agree that should there be insufficient fu
11、nds in my/our Bank account to meet my transfer hereby authorized, the Bank shall be entitled, at its discretion, not to effect such transfer in which event the Bank may make the usual service charge to be paid by me/us. This authorization shall have effect until further notice or until the expiry da
12、te written below (whichever shall first occur). 7. I/we agree that any notice of cancellation or variation of this authorization which I/we may give to my/our bank shall be given at least two workings days prior to the date on which such cancellation/variation is to take effect and at the same time
13、such notice shall be given to the beneficiary. 1.本人等現授權本人等的下述銀行， 根據受益人或其往來銀行不時給予本人等銀的指 示自本人等的戶口內轉賬予親切親切受益人 ，惟每次轉賬金額不得超過下的限額。 2.本人等同意本人等的銀行母須證實該等轉賬通知是否已交予本人等 。 3.如因該等轉賬而令本人等的戶口出現透支或令現時的透支增加 ，本人等願共同及各別 承擔全部責任。 4.本人等確認本人等在此表格上的簽署與本人等用以轉賬的戶口的簽署相同。 5.本授權書將繼續生效直至另行通知為止。 6.本人等同意會通知親切親切受益人任何銀行戶口的變更或取消交費方式，亦同意如本人等 的戶口並無足夠款項支付該等授權轉賬，本人等的銀行有權不予轉賬，且銀行可收取慣常的收 費。本授權書將繼續生效直至另行通知為止或直至下列到期日為止以兩者中最早的日期為準 。 7.本人等同意，本人等取消或更改本授權書的任何通知，須於取消/更改生效日最少兩個工 作天之前交予本人等的銀行及受益人。NOTE * Please ensure that you sign the form as well as any alterations in the same way as you sign your account.簽名必需與閣下之戶口簽名完
