Donation Form

Thank you for supporting Hospital Lam Wah Ee. Please complete the information below so that we can process and record your donation accurately.
For more details on making a donation via Bank Transfer, Cheque or Cash, please click here.

Donation Bank Account

Bank: CIMB Bank

Account No: 8601008701

Account Name: Hospital Lam Wah Ee

For all matters of enquiry on donation you may contact our Finance team at +604 652 8888 Ext: 1150 or 1241 or email to [email protected].

1. Donation Information

Donate As *

Individual

Donation made by an individual.

Company

Donation made by a company or organisation.

Please select whether the donation is made as an individual or company.

Tax *

Please select a tax option.

Amount (RM) *

Please enter a valid donation amount.

2. Individual Donor Information

Full Donor's Name *

Please enter your full name.

Identification Type *

MyKad No.

Passport No.

MyKad / Passport No. *

Please enter your MyKad or Passport number.

Residential Address *

Please enter your residential address.

Contact Number *

Please enter a valid contact number.

Email Address *

Please enter a valid email address.

2. Company Information

Company Registration Name *

Please enter the Company Registration Name.

Company Registration No. *

Please enter the Company Registration No.

Contact Information

Email Address *

Please enter a valid email address.

Mobile No. *

Please enter a valid mobile number.

Address *

Please enter the company address.

3. Payment Information

Mode of Payment *

Please select a Payment Slip Type.

Upload Transaction Slip *

Upload Transaction Slip Photo or Document

Accepted formats: JPG, PNG, PDF
Maximum file size: 5 MB

Please upload a valid transaction slip.

I have verified the above information and understand that changes to the receipt are not permitted once it is issued.
I hereby consent for the details I have provided to be used for donation purposes only.
Kindly refer to PDPA for details on our data protection policy. *

Please confirm that you have verified the above information.

For Tax-Deductible donations, donor information fields are mandatory. For Non-Tax-Deductible donations, donor information fields are optional.