復康用品捐贈表格Rehabilitation Products Donation Form

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捐贈者資料 Donor’s Information

姓名Name: *

電話Tel: *

傳真Fax:

電郵Email:

地址Address:

機構名稱 (如有) Name of Organization (If any)

商業登記証號碼 (如有) Business Registration Number (if any) :

職位 Post :

機構電話 Tel :

捐贈用品資料 Rehabilitation Product Donated (請註明每項捐贈用品數量 Please specify the quantity of each product) *

衛生用品 ( 如:尿片, S碼 ) Sanitary product ( e.g : Adult diapers, Size S )

營養品 ( 如:奶粉) Health Supplement ( e.g : Milk Powder )

其他 Others

Required

物品 Product *

數量 Quantity *

到期日 Expiry Date *

YYYY

備註 Remarks

捐贈方式 Way of Donation *

於辦公時間內把上述物品送到香港復康諮詢協會。（星期一至五：9:30-17:30） We will deliver the product during office hours to Hong Kong Rehabilitation A & E Association Ltd. (HKRAEA Working hours: 9:30-17:30 on Mon-Fri)

(已停止上門回收)相約上門回收上述物品（如回收地址與上述不同，請註明）(Temporary suspended) We would like HKRAEA to pick up the product from us. (Please specify below if the pick-up address is different from the address above.)

Required

（如回收地址與上述不同，請註明）回收地址 Pick-up Address：

請細閱以下須知：Please read the following terms and conditions carefully :

1. 本會將保留復康用品之一切使用權，謹慎審批每個借用、轉贈及轉售申請，以確保資源用得其所。
Hong Kong Rehabilitation A & E Association reserves all rights to the rehabilitation product. The Association will consider every application carefully to ensure the product donated will be lent / sold / given to the right persons in need.

2. 捐贈者的資料會絕對保密，所有資料只作捐贈復康用品及通訊用途。
The donor’s information will only be used for the processing of donation and communication and will not be disclosed to the third party.

3. 如有任何查閱、更改資料或有關事宜，請與本會職員聯絡。
If the donor would like to gain access to or amend any information, please contact our staff member.

4. 請把已填好之表格寄回、傳真或親身光臨本協會遞交。
Please send us the completed form by post / fax / in person.

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