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Alumni Atrium
Special Nameplates
Confirmation of Donation

All fields marked with an asterisk (*) are required.

I/ Our Organization hereby confirm(s) to make the following donation to The Hong Kong Polytechnic University:

Amount of Donation Acknowledgement Size of Nameplate
HK$ 38,000 or above Gold Rectangular Metal Nameplate in the Multi-function Hall 400mm (W) x 70mm (H)
HK$ 28,000 or above Wooden Rectangular Nameplate at the entrance lobby
HK$ 18,000 or above Silver Rectangular Metal Nameplate in the Multi-function Hall 200mm (W) x 70mm (H)
I would like to donate HK$ to support university development.
(For donation of HK$500 or above, the name of the donor will be displayed on the monitor at the entrance lobby of the Alumni Atrium as acknowledgement.)
Total Amount of Donation: HK$ ----------
Nameplate Inscription
A maximum of two lines of individual/organization name in Traditional Chinese or English can be inscribed on each nameplate.
Maximum Number of Letters per Line
(Including punctuation and space)
Gold Rectangular Metal Nameplate & Wooden Rectangular Nameplate
- Traditional Chinese characters: 20 characters
- English letters: 36 letters
Silver Rectangular Metal Nameplate
- Traditional Chinese characters: 10 characters
- English letters: 16 letters
The illustration is sheer fabrication. Any resemblance to real persons or companies is purely coincidental.
Name(s) to be inscribed
First Row
(Number of Characters/Letters: 0)
Second Row
(Number of Characters/Letters: 0)


  1. If you wish to donate more than one nameplate, please use separate form for each subscription.
  2. The University reserves the right to decline any inscription as deemed inappropriate. Should the designated location of the nameplates be required by the University for other purposes, other form of acknowledgement deemed appropriate by the University will be arranged.
Donor Information
(English, surname first)
(English, surname first)
Affiliation with PolyU (If applicable):
Staff ID:
Student ID:
Payment Method

Name of Card Holder (as shown on the credit card):
Amount: HK$
# Online credit card payment is applicable to donation of HK$100,000 or below only. It will be proceeded at the Jetco Payment Gateway secure website after clicking the “Submit” button. All data will be transmitted in encrypted format.

Cheque No.:
Amount: HK$
# Please make the cheque payable to “The Hong Kong Polytechnic University” and send it to the Alumni Affairs and Development Office, Rm M1504, 15/F, Li Ka Shing Tower, PolyU, Hung Hom, Kowloon (Attn: Miss Eva Tsang). Please mark your name and tel no. on the back of the cheque.
Name on Donation Receipt#:
# A tax-deductible receipt for donations of HK$100 or above will be issued by PolyU

Donor Acknowledgement

Donors who have made cumulative donations of HK$20,000 or above to the University since November 1994 shall be honoured as a member of The Hong Kong Polytechnic University Foundation (PolyU Foundation). Please refer to www.polyu.edu.hk/aado/polyufoundation for details.

Declaration in relation to application for the Government’s Matching Grant
I/ Our Organization acknowledge(s) and agree(s) that if eligible, PolyU will apply for a grant that matches this donation from the Government or its related bodies including the University Grants Committee, by submitting details of my/ our donation and I/ our organization have/ has no objection to the disclosure of my name/ our organization’s name, purpose and details of my/ our donation to the Government or its related bodies.

Personal Information Collection Statement

Please read our Personal Information Collection Statement at www.polyu.edu.hk/aado/PICS.pdf.

Use of Personal Data in Direct Marketing

The Hong Kong Polytechnic University would like to use your name, address, telephone number, fax number and email address to inform you of the following activities, services and facilities (collectively, “the marketing subjects”):

  • Activities, seminars or workshops organized by us alone, jointly with other parties or by other parties;
  • Privileges, discounts and offers for services provided by us alone or jointly with other parties; and
  • Charitable, educational, social and other activities that solicit contributions, donations or participation.

We cannot use your personal data for sending information on the above marketing subjects to you unless we have received your consent. Please tick the box below to indicate your agreement for us to use your personal data to send you information on the above marketing subjects.

You may withdraw from receiving information on the marketing subjects indicated above at any time by sending an email to the Departmental Personal Data Officer at almail@polyu.edu.hk.

I agree The Hong Kong Polytechnic University to use my personal data to send me information on the marketing subjects indicated above.

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