Montreal Children's Hospital Foundation

Gift Confirmation Form

I have included The Montreal Children's Hospital Foundation in my estate plan. I understand this document will be used for information purposes only. I can notify The Foundation of the future changes that may affect this gift.

Field Is Required I have included The Montreal Children's Hospital Foundation as a beneficiary in my:

If other, please specify:

Please specifiy the amount of your legacy Gift:

Or specify the percentage (%) and the estimated value of your estate:

If you do not wish to disclose an amount, check this box:

I do not wish to disclose an amount (kindly note that we cannot allocate the matched gift if no amount is indicated).

I would like the Legacy Challenge matching funds to benefit (please choose one priority):

I would like my legacy gift to be directed to:

The most urgent needs of The Children's
A specific area or program

If you selected a specific area, please specify:

Field Is Required The MacKenzie Forbes Society honours legacy donors. Do you wish to be recognized?

This letter of intent is an expression of my existing plans. I understand that I may alter or revoke these plans and that this form does not impose any legally binding obligations upon myself or my estate.

Field Is Required First Name

Field Is Required Last Name

Field Is Required Date of Birth:

Field Is Required Email:

Yes, I would like to receive email from La Fondation de l'Hôpital de Montréal pour enfants

Field Is Required Please retype your name to confirm your intentions: