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Monthly Donation Amount
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$10
$25
$50
$100
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DONOR INFORMATION
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Name
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Email
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Contact Number
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NRIC / FIN No. (required for automatic tax-deduction)
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Date of Birth (DD/MM/YYYY)
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By filling this donation form, it is deemed that I have consented for Assisi Hospice to use my personal information for donation-related and communication purpose.
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I agree
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PAYMENT INFORMATION (Credit/Debit Card)
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Card Holder Name
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Card Type
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1.
Visa
2.
Mastercard
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Amex
4.
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Card Number
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Card Expiration (MM/YY)
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Summary
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