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Donation Inquiry
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Email
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Your email
Please select your category
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Local Individual
Local Organization
Overseas Individual
Overseas Organization
Your Name
*
Your answer
Address (including the Country)
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Your answer
Contact person (for organizations)
Your answer
Contact telephone no
*
Your answer
Please tick all that apply
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I can organize direct donations of drugs/reagents/surgical items from foreign suppliers
I can fund foreign suppliers of local agents to send required items from the country of origin
I can organize direct donations of drugs/reagents/surgical items from local suppliers
I can fund local agents to source required items to the hospital
I can make a monetary donation to procure required items to the hospital
Required
If there is specific item you would like to donate, or if there are any conditions please leave a remark here
Your answer
Please mention the maximum value of the donation (select the currency in the next dropdown box)
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This is to match your contribution with our requirements.
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Currency
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Please enter the 3 letter currency code (Eg: LKR/USD/GBP/AUD/EUR/SGD/NZD/CAD/JPY...etc)
Your answer
Please select yes if you want LRH account details to make a monetary donation.
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