Please fill in the following fields. Fields marked with an * are required.
请填写以下表格。(*)代表必须填写的部分
Gender 性别:
男 Male
女 Female
*English Name姓名(英):
Chinese Name姓名(中):
* NRIC/PASSPORT NO.
登记/护照号码:
Date of Birth 出生日期:
(eg. 24/06/1972)
Street Address 1 :
地址 1
eg. Blk 2 Ang Mo Kio Ave 2
Street Address 2:
地址 2
eg. #06-15 Ocean Court
State 省 :
City 市 :
Country 国家 :
Afghanistan
Albania
Algeria
Andorra
Angola
Anguilla
Antarctica
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia
Botswana
Bouvet Island
Brazil
Brunei Darussalam
Bulgaria
Burundi
China
Christmas Island
Congo
Cook Islands
Costa Rica
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
France
French Guiana
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea-bissau
Guyana
Hong Kong
Hungary
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
Korea, Republic of
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libyan
Liechtenstein
Lithuania
Luxembourg
Macau
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Moldova, Republic of
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russian Federation
Rwanda
Singapore
Sri Lanka
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican
Venezuela
Viet Nam
Western Sahara
Yemen
Yugoslavia
Zaire
Zambia
Zimbabwe
Postal Code 邮区
*Email 电子信箱 :
* Tel.联络号码 :
(Home 住宅)
(Mobile 手机)
(公司 Office)
(传真 Fax)
Please tick the button of the amount you wish to contribute.
For other amount, please tick the "Other amount" button and enter the amount in the box.
SGD
$10
Enets Internet Banking
(Please have a valid Internet Banking account with Citibank, DBS/POSB or UOB)
Credit Card
感谢您的捐助
Thank you for your contribution!