DONATION FORM

Building greatness through giving

I would like to make a:

one-time gift of $ ______

monthly gift of $ ______(I authorize NTU to deduct this monthly amount from my credit card below. This shall

remain in force until notification of cancellation in writing by me).

Please designate my gift to:

NTU BursariesNTU Education & Student Life

School Advancement ______

Please specify:ADM, CEE, EEE, EOS, HSS,LKCMed, MAE, MSE, NBS, NIE, RSIS, SBS, SCBE, SCE, SPMS, WKWSCI

I am paying by:

Cheque (please make payable to ‘NTU’)

Visa/ MasterCard/ AMEX ______Expiry ______month _____ year

Name of Cardholder ______

Individuals / Corporations/ organisations
______
Name (Dr/ Mr/ Mrs/ Mdm/ Ms)*
______
NRIC/ FIN
(For auto-inclusion in IRAS tax assessment for tax deductibility) / ______
Company name
______
Unique Entity Number (UEN)/ ROB/ROC*
(For auto-inclusion in IRAS tax assessment for tax deductibility)
______
Contact person (Dr/ Mr/ Mrs/ Mdm/ Ms)*
______
Designation

* Delete accordingly

Address ______

Contact ______Email ______Office ______Mobile

Please recognise this gift in the name of:the donor as above ______

I declare that I am the user and/or subscriber of the telephone number(s) provided by me above, that I have read and understood the Personal Data & Consent Statement shown overleaf, and I hereby give my consent.

______

Signature/ Date

Please mail completed form to: Development Office, Nanyang Technological University, Block N2.1, Level B4, 76 Nanyang Drive, Singapore 637331
Tel: (65) 6790 6080 Fax: (65) 6792 6627

ADM - School of Art, Design and MediaCEE - School of Civil and Environmental Engineering

EEE - School of Electrical and Electronic EngineeringEOS – Earth Observatory Singapore

HSS - School of Humanities and Social SciencesLKCMed-Lee Kong Chian School of Medicine

MAE - School of Mechanical and Aerospace EngineeringMSE - School of Materials Science and Engineering

NBS - Nanyang Business SchoolNIE- National Institute of Education

RSIS - S Rajaratnam School of International StudiesSBS - School of Biological Sciences

SCBE - School of Chemical and Biomedical EngineeringSCE - School of Computer Engineering

SPMS - School of Physical and Mathematical SciencesWKWSCI - Wee Kim Wee School of Communication and Information

Personal Data Notice & Consent

  1. I hereby consent to allow Nanyang Technological University and its agents (collectively “NTU”) and NTU’s third party service providers to collect, use, disclose personal data about me that I now provide NTU with andthat NTU possesses about me for the following purposes :

(a)Provide me with marketing, advertising and promotional information and materials relating to fundraising products and services that NTU may be selling, marketing, offering or promoting;

(b)Send me such marketing, advertising and promotional information through any or all of the following modes of communication :

(i)postal mail and/or electronic transmission to my email address; and

(ii)to my telephone number(s) by way of :

(1) voice call / phone call

(2) SMS/MMS (text messages)

(3) fax

I also consent to agents of NTUand third party service providers engaged by NTU sending me such marketing, advertising and promotional information through the above modes of communication on behalf of NTU; and

(c)maintain donor registries, including storage and back up of such registries.

(collectively “the Purposes”)

  1. NTUmay need to disclose your personal data to third parties, whether located within or outside Singapore, for one or more of the above Purposes, as such third parties, would be processing your personal data for one or more of the above Purposes.
  1. NTU’s disclosure of the personal data of individuals to third parties shall be in compliance with the PDPA. NTU will put in place reasonable security arrangements to ensure that the personal data of individuals disclosed to third parties is adequately protected and secured. Appropriate security arrangements will be taken to prevent any unauthorized access, collection, use, disclosure, copying, modification, leakage, loss, damage and/or alteration of such personal data.
  1. You may withdraw consent to the above at any time by giving reasonable notice in writing to us at .
  1. If you have any questions relating to our collection, use and disclosure of your personal data or the matters set out in this document, you may contact our Office at .