EPNOX x ROSE – Offline Donation Form

Thank You for donating to Program ROSE.
Follow the steps below:

1. Scan the DuitNow QR and screenshot/save the transaction.

2. Fill up the donation details below.

3. Upload your transaction slip.

(* Tax-exempt receipt will only be issued for donations of RM50 and above)

Full Name / Company Name *

Title (E.g. Mr., Miss, Dr., Datuk, etc.)

IC or Passport Number / Company Registration Number *

Mailing Address *

Email Address *

Phone Number *

Donation Amount (RM) *

Please upload your transaction slip as proof. *

Please upload your transaction slip as proof.