(eenmalige) Machtiging via Internet Ja, ik help moeders aan een gezondere toekomst en steun het werk van Simavi! Simavi mag het volgende (eenmalige) bedrag van mijn rekening afschrijven:

Bedrag:* €   Per:   maand kwartaal half jaar jaar eenmalig Ingangsdatum: * Bank/Gironummer:* Geslacht:* Man Vrouw Voorletter(s)/ tussenvoegsel/ achternaam:* Straatnaam en huisnr:* Zip code: City:* Country: Nederland Afghanistan Albania Algeria Andorra Angola Anguilla Antigua Antilles, Netherland Argentina Armenia Aruba Ascension Australia Austria Azerbaijan Azores Bahamas Bahrain Bangladesh Barbados Barbuda Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire Bosnia-Herzegovina Botswana Brazil British Indian Ocean Terr British Virgin Islands Brunei Bulgaria Burkina Faso Burma (Myanmar) Burundi Cambodia (Kampuchea) Cameroon Canada Canary Islands Cape Verde Cayman Islands Central African Republic Chad Channel Islands Chile China Christmas Island Cocos (Keeling) Island Colombia Comoros Congo Cook Islands Corsica Costa Rica Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador England Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern/Antarctic Gabon Gambia Gaza Strip Georgia, Republic of Germany Ghana Gibraltar Great Britain Greece Greenland Grenada Guadeloupe Guatemala Guernsey Guinea Guinea-Bissau Guyana, British Haiti Heard and Mcdonald Island Holland Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Iraq-Saudi Neutral Zone Ireland, Republic of Israel Italy Ivory Coast Jamaica Japan Jersey Jordan Kampuchea Kazakhstan Kenya Kiribati Korea, North Korea, South Kosrae Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia, Republic of Madagascar Madeira Islands Malawi Malaysia Maldives Mali Malta Martinique Mauritania Mauritius Mexico Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherland Antilles Nederland Nevis New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Islands Northern Ireland Norway Oman Pakistan Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Pohnpei Poland Portugal Puerto Rico Qatar Reunion Romania Rota Russia Rwanda Saba Saipan San Marino (Italy) Sao Tome & Principe Saudi Arabia Scotland Senegal Serbia Seychelles Sierra Leone Singapore Slovakia (Slovak Republic) Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka St. Barthelemy St. Christopher St. Eustatius St. Helena St. Kitts St. Lucia St. Maarten St. Martin St. Pierre & Miquelon St. Vincent Sudan Suriname Svalbard and Jan Mayen Is Swaziland Sweden Switzerland Syria Tahiti Taiwan Tajikistan Tanzania Thailand Tinian Togo Tokelau Tonga Tortola Trinidad and Tobago Tristan Da Cunha Truk Tunisia Turkey Turkmenistan Turks & Caicos Islands Tuvalu Uganda Ukraine Union Island United Arab Emirates United Kingdom United States Uruguay US Minor Outlying Islands Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands (British) Wake Island Wales Wallis & Futuna Islands West Bank Western Samoa Western Saraha Yap Yemen Yugoslavia Zaire Zambia Zimbabwe Telefoonnummer:* E-mailadres* Geboortedatum (dd-mm-jjjj):* Hoe wilt u door Simavi op de hoogte gehouden worden? 4 x per jaar per post 1 x per jaar per post via het jaarverslag per digitale nieuwsbrief Anders, namelijk Remarks: Here can you put supplementary comments. * verplicht in te vullen