Toggle navigation
MAKNA (Majlis Kanser Nasional)
back to Reasons To Give
Donor Details Form
Title
*
Mr
Mrs
Miss
Full Name
*
E-Mail
*
NRIC / Passport
*
Race
-- Please Select --
Chinese
Indian
Malay
Others
Mobile Number
*
Address
*
Postcode
*
Country
*
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Croatia
Cuba
Cyprus
Czech Republic
Democratic Republic of Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea-bissau
Guyana
Haiti
Heard Island and Mcdonald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Ivory Coast
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territory
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russia
Rwanda
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Pierre and Miquelon
Saint Vincent and The Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and The South Sandwich Islands
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan
Tajikistan
Tanzania
Thailand
Timor-leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
State
*
Kuala Lumpur
Johor
Kedah
Kelantan
Labuan
Melaka
Negeri Sembilan
Pahang
Penang
Perak
Perlis
Putrajaya
Sabah
Sarawak
Selangor
Terengganu
Select your donation amount
*
RM 38.00 - Every Month
RM 58.00 - Every Month
RM 88.00 - Every Month
RM 228.00 - Every 6 Months
RM 348.00 - Every 6 Months
RM 528.00 - Every 6 Months
RM 456.00 - Every Year
RM 696.00 - Every Year
RM 1056.00 - Every Year
RM 10.00 - Every Month
RM 20.00 - Every Month
RM 30.00 - Every Month
Donation method
*
Credit or Debit Card Details
Name on Card
*
Card Number
*
Issuing Bank
*
Affin Bank Berhad
Affin Islamic Bank Berhad
Alliance Bank Malaysia Berhad
AmBank (M) Berhad
AmIslamic Bank Berhad
Bank of China (M) Berhad
Bank Islam Malaysia Berhad
Bank Kerjasama Rakyat Malaysia Berhad
Bank Simpanan Nasional
CIMB Bank Berhad
CIMB Islamic Bank Berhad
Citibank Berhad
Hong Leong Bank Berhad
HSBC Amanah Malaysia Berhad
HSBC Bank Malaysia Berhad
Industrial and Commercial Bank of China (Malaysia) Berhad
Malayan Banking Berhad
Maybank Islamic Berhad
OCBC Bank (Malaysia) Berhad
Public Bank Berhad
Public Islamic Bank Berhad
RHB Bank Berhad
RHB Islamic Bank Berhad
Standard Chartered Bank Malaysia Berhad
United Overseas Bank (Malaysia) Berhad
Issuing Bank
*
Affin Bank Berhad
Affin Islamic Bank Berhad
Alliance Bank Malaysia Berhad
Alliance Islamic Bank Malaysia Berhad
Al Rajhi Banking & Investment Corporation (Malaysia) Berhad
AmBank (M) Berhad
Bank Islam Malaysia Berhad
Bank Kerjasama Rakyat Malaysia Berhad
Bank Muamalat Malaysia Berhad
Bank of China (M) Berhad
Bank Pertanian Malaysia Berhad (Agrobank)
Bank Simpanan Nasional
CIMB Bank Berhad
CIMB Islamic Bank Berhad
Citibank Berhad
Hong Leong Bank Berhad
Hong Leong Islamic Bank Berhad
HSBC Amanah Malaysia Berhad
HSBC Bank Malaysia Berhad
Industrial and Commercial Bank of China (Malaysia) Berhad
Kuwait Finance House
Malayan Banking Berhad
MBSB Bank Berhad
OCBC Bank (Malaysia) Berhad
Public Bank Berhad
RHB Bank Berhad
RHB Islamic Bank Berhad
Standard Chartered Bank Malaysia Berhad
Standard Chartered Saadiq Berhad
United Overseas Bank (Malaysia) Berhad
Expired Date
*
January
February
March
April
May
June
July
August
September
October
November
December
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
Card Type
*
Bank Account Details
Account Type
*
Savings
Current
Account No.
*
Bank Name
*
How did you hear about us?
-- Please Select --
Newspaper
Website
Social Media
E-Mail
Others
Terms and Conditions
Please read the
Terms and Conditions
before you complete the registration.
I have read, understood and agree with the
Terms and Conditions.
By checking this box you would like to receive more information about our services, events, and news.
Submit