Please fill in the form hereafter. You can either chose to handover
personally €50 to Christian or to transfer €50 on his account:

 

Payable to:

International identification:

310-0090081-54

Christian PHILIPPE
Rode Beukendreef, 12

1930 Nossegem

 

Bank: ING Vilvoorde

Address: Varkensmarkt, 1

              1800 Vilvoorde

IBAN nr: BE42 310-0090081-54

SWIFT nr: BBRUBEBB

 

For Belgian citizens who like a fiscal statement, please transfer to :

Account: 210-0430651-23

Amount: €50

Beneficiary: Medico Lions Clubs Belgium

Communication: A Tap for Vietnam

E-mail Address: *
Surname *
Firstname
Address and Nr
Post code and city
Country
The amount of tap(s) I want is *
I pay cash to Christian PHILIPPE
I transfer the amount on 310-0090081-54
I am Belgian, want a fiscal statement and transfer to 210-0430651-23
* Required