Life Insurance Policy Donation

Reply Form

Your information will remain confidential and you are free to change your mind about your gift at any time.

(Please note : This reply form is only for our records and has no legal effect.)

If you wish to submit via traditional method, please download the form below and send it back to us.

PDF Version

"*" indicates required fields

1Donation Detail

2Personal Information

Life Insurance Policy Giving

Percentage % to be Donated to Caritas Hong Kong*

Please enter a number from 0 to 100.

Name of Insurance Company*

Policy Number*

Name of Agent*

Agent's Registered Number*

Personal Information

Title*

English Name*

First Name Middle Name Last Name

Chinese Name*

Given Name Surname

Contact Number*

ID/ Passport Number

Optional

Email*

Please provide a valid email address. Confirmation and donation e-receipt (if applicable) will be sent to this email.

Enter Email Confirm Email

Address

Street Address Address Line 2

I wish to be contacted by*

Phone

I agree to the privacy policy.

*The personal data collected will be treated as strictly confidential and will be used by CARITAS Hong Kong and its service providers for the purposes of donation administration, receipt issuance and related communications.

Comments

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Life Insurance Policy Donation

Reply Form

Life Insurance Policy Giving

Personal Information

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