Khyentse Foundation Australia Donations Thank you! Your generous support makes all the difference. All donations from Australia are handled by our sister organization, Siddhartha’s Intent Australia, a charitable organization incorporated in Australia. Please complete this form and return it to the address below.

I wish to make a one-time donation of AU$_________________ to Khyentse Foundation. I wish to make a monthly donation of AU$_________________ starting date _______________ This qualifies me for the Monthly Donation Matching Funds Program, which will double my contribution to Khyentse Foundation. I will arrange a monthly payment from my bank account or credit card.

Name______________________________________________________________________________

Address ___________________________________________________________________________

City ________________________ State _________________ Postal Code ____________________

Phone ____________________________________ Email ___________________________________

Signature______________________________________________Date ________________________

Please check here if you wish to remain anonymous

PAYMENT BY CHEQUE Please make your crossed cheque payable to: Siddhartha’s Intent Australia. (Please write your name and specify “For Khyentse Foundation” on the back) PAYMENT BY CREDIT CARD All credit card donations are processed through the Khyentse Foundation website at www.khyentsefoundation.org. Click “Share the Merit” and follow the instructions. PAYMENT BY DIRECT DEPOSIT

Bank Name: St. George Bank Account Name: Siddhartha’s Intent Australia BSB: 112-879 Account No: 130190771

PAYMENT REFERENCE: Please include a payment reference with your direct deposit i.e. KF [Your Name] (e.g. “KF S Smith). This reference helps us identify and credit your donation. If you make a deposit at a bank branch, please ask the teller to use the number “53” as a reference and send us an email stating the date and amount of your deposit. Please email a scanned copy of this completed donation form with your cheque, deposit payment slip, and/or other documents to: Chantal@khyentsefoundation.org Or send via postal mail to:

Khyentse Foundation/Siddhartha’s Intent Australia C/O Chantal Gebbie 37 Susan Street Annandale NSW 2038