國立成功大學接受捐贈表 NCKU Donation Form

合計金額Total amount

合計新台幣 A total of NT$ 元整

合計外幣 A total of (foreign currency) 元整匯率 the exchange rate being，折合新台幣which is NT$ 元整

捐贈用途 Purpose of donation

不指定(由權責單位統一管理)Unspecified(managed by the responsible unit)

指定受贈單位 Specify 用途 as the receiving unit for the purpose of

其他(詳述說明) Others(describe in detail)

是否附有負擔 Liability transferred together with the donation

是(須說明)Yes(please explain)

否 No

補充說明 Purpose of donation

說明：

捐贈證明Proof of donation

要 Required 不要 Not required

芳名錄 Donor Disclosure Agreement

同意將姓名、捐款金額刊登於本校相關網站或刊物上。
I agree to have my name and donation listed on relevant NCKU websites or in publications.

同意以之名，將捐款金額刊登於本校相關網站或刊物上。
I agree to the name of disabled and the donation being listed on relevant NCKU websites or in publications.

不同意 I do not agree to either of the above.

捐贈者意思表示文件或檢附來文 Donor consent document (or attach said document)

公文字號 Official document number：

請附證明文件 Please attach a copy of the receipt：

提醒：請附上捐贈同意書或公文，個人捐贈需簽名、機關 /構捐贈需用印，並請附上價值證明文件（例如：收據、發票、出貨單、銷貨單等）。

個資聲明Privacy Statement

我同意國立成功大學於法律許可範圍內處理及利用個人資料提供資訊或服務，詳細個資蒐集利用聲明請參閱。 I agree that the National Cheng Kung University will process and use personal data to provide information or services within the scope of the law. Please refer to the detailed Personal Data Collection and Usage Declaration This field is required.

捐贈項目 Donation Item