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Transaction
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Personal information
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Payment
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Donation in memory of someone
Transaction
Name of the deceased:
Date of death:
I would like to make my donation for a hospital, a department or a care sector. Please specify:
I would like to notify the family (the value of the donation is kept confidential):
yes
no
If you wish to notify the family of your donation, please indicate the contact details of the person below.
Donation amount
Subtotal:
Total:
$
Total:
$
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Organization's registration number:
11892 3234 RR0001
Time remaining in your session:
20
Time remaining in your session:
20