HSWAGATA BUDDHA TOOTH RELICS PRESERVATION MUSEUM
LAY DONATION INTENTION & PROTECTION FORM
Form Code: HSW-F28
Date: ____ / ____ / ______
Form Number: ___________________________
1. DONOR DETAILS
1.1 Name: _______________________________________
1.2 Address:
____________________________________________
____________________________________________
1.3 Phone / Email:
____________________________________________
2. TYPE OF DONATION
[ ] Cash
[ ] Relic
[ ] Religious object (stupa, statue, etc.)
[ ] Service / labour
[ ] Other: _____________________________________
Short description:
_______________________________________________
_______________________________________________
3. DONOR INTENTION
(Why does the donor give this gift?)
3.1 Donor’s wish or intention:
___________________________________________
___________________________________________
3.2 Is this donation linked to a special wish,
ceremony, or merit-making?
[ ] Yes [ ] No
If yes, please explain:
___________________________________________
4. CONDITIONS AND ETHICAL POINTS
4.1 The donor requests:
[ ] No titles or special honours
[ ] No political use of my name or gift
[ ] My name to be kept private / anonymous
[ ] Other conditions:
_______________________________________
4.2 Museum promise to protect donation and intention:
___________________________________________
___________________________________________
5. RISK NOTES (IF ANY)
(For internal use: conflict of interest, public risk, etc.)
_______________________________________________
_______________________________________________
6. SIGNATURES
Donor:
Name: ________________________________________
Signature: __________________ Date: ____/____/____
Museum Representative:
Name: ________________________________________
Role: ________________________________________
Signature: __________________ Date: ____/____/____
