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I want my donation to be used for the following: I want my donation to be used for the following: Eye Cataract Surgery Eye Cornea Grafting Cardiac & Diebetic Dentistry Dialysis Oral Cancer Surgery

My Donation Is: My Donation Is: Charity Zakat

I want my donation to be confidential: I want my donation to be confidential: Yes No

I consent to being contacted on email about welfare & other pebs activities I consent to being contacted on email about welfare & other pebs activities Yes No

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I would like a receipt mailed/emailed to me I would like a receipt mailed/emailed to me Yes No