Médecins Sans Frontières Hong Kong Legacy Program PLEDGE FORM Thank you for your kind support of MSF’s worldwide medical humanitarian relief work. Your promise of future support is deeply appreciated by us, by our field workers in the frontline, and by the people MSF serves. A bequest is one of the most effective ways you can help MSF prepare for the future, enabling us to continue providing crucial medical aid where and when it is most needed. Please fill out the following information: □ I have made a bequest to MSF-HK. Contact person name and telephone number: __________________________________ □ I have named MSF-HK as a beneficiary of my life insurance policy. Policy No: _______________________________________________________________ Bequest Amount: _________________________________________________________ □ □ I intend to leave MSF-HK a legacy, please follow up with me. □ □ I am interested in legacy giving and would like to receive more information. I intend to name MSF-HK in my life insurance policy, please follow up with me. I would like to know more about MSF. Please include me in your mailing lists. Name: _________________________________________________________________________ Telephone: _____________________________________________________________________ Email: _________________________________________________________________________ Address: _______________________________________________________________________ MSF Donor ID (if applicable) no: ____________________________________________________ Language preference: □ English □ Chinese * Please return the completed Pledge Form to MSF-HK at 22/F Pacific Plaza, 410-418 Des Voeux Road West, Sai Wan, Hong Kong, or fax it to (852) 2337 5442