Page 67 - Annual Report 2016-2017

Donation Form

(Please fill in and tick as appropriate.)
I / My organisation would like to make a donation to City University of Hong Kong.
Donation Amount
HK$10,000,000 HK$5,000,000 HK$1,000,000
HK$500,000 HK$200,000 HK$100,000
HK$50,000 Others, Please specify:

Purpose(s) of donation
University general development
Academic and research activities
Student scholarships and awards
Campus development projects
Other area(s), please specify:
I / My organisation agree(s) that the University would apply for the Government Matching Grant with my donation
whenever available and the matching grant, if any, would be used to support the University general development.
I enclose a cheque (cheque no. ) payable to “City University of Hong Kong”.

Please issue official receipt addressing the following person or organisation:

(The receipt can be used for tax deduction purpose in Hong Kong.)

Acknowledgement
Please state the preferred name to be listed on acknowledgement:

(English) (Chinese)
(For acknowledgement taking the form of naming, the duration of naming a facility/ programme/ project ordinarily continues as long as it remains in being.
The University reserves the right to discontinue the use of the name if it is in conflict with any naming policies of the University.)
I / My organisation wish(es) to remain anonymous in all donor listings.

Signature: Date:
Name of donor:
Name of contact person: Position:
Company name:
Contact address:
Contact tel.: Mobile:
E-mail: Fax:
Thank you for your generous support to CityU!

For any enquiries about the CityU Foundation, please contact us at (852) 3442 6388 or visit
http://www.cityu.edu.hk/foundation
The above data will be kept confidential and used by CityU for administrative and communication purposes.
If you do not wish to receive fundraising information from CityU, please let us know.