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We thank you for your interest in making a contribution to Islamic Relief Malaysia

ISLAMIC RELIEF DONATION FORM

YES, I WOULD LIKE TO CONTRIBUTE

1. Personal Details
Name:
Address:
City:
Postal code:
E-mail address:
Telephone No (Fixed/Mobile).:
2. Donation Details
ORPHANAGE LIBRARY PROJECT - "EKSPEDISI MERDEKA SATU MALAYSIA (EM1M)" Amount:RM
OTHER APPEALS
Seasonal Appeal/Campaign
Amount
1.
2.
3.
4.
5.
Emergency Appeal
Amount
6.

7.
8.
9.
10.
METHOD OF PAYMENT
Perbankan Online CIMBCLICKS/ Online Banking CIMBCLICKS
Perbankan Online MAYBANK2U/ Online Banking MAYBANK2U
Registered Payment Merchant - IPAY88 (Credit Card and other Online Banking)

Note: Please specify the amount and to which appeal that you would like to donate to and upon completing this form click below link to donate.