By filling in the following form, you authorize Stichting Cambodia-Dutch to debit a certain amount. You also indicate a frequency to debit the amount.

    Your name (required field)

    Street (required field)

    Postal code (required field)

    City (required field)

    Your email (required field)

    Phone number (required field)

    Bank account number (required field)

    Amount in Euro (required field)

    Choose your purpose of the donation

    Frequention of donatien


    By sending this form, I authorize Stichting Cambodia-Dutch to debit the indicated amount per desired period from my bank or giro account.
    You will receive a confirmation of your registration by e-mail.

    You can withdraw your authorization at any time without stating reasons. We will refund the amount within thirty days of the debit.

    ANBI : 8195 41 552 | KvK : 17227679

    Stichting Cambodia-Dutch has been designated by the Tax Authorities as a Public Benefit Institution (ANBI). Donations are therefore deductible for private individuals. For more information: