Aum Sri Sai Ram
SHRI LALITHAMBIGA TRUST
Regd.Office: 5/11, Sivakami Nagar, S.B.I.Post, Coimbatore 641007. INDIA
Application for Donors – Life Time Patron Programme |
No:-----------------------
Date:------------------------
Name:------------------------------------------------------
Gender: Male/Female-----------------------------------
Nationality:------------------------------------------------
Date of Birth:---------------------------------------------(DD/MM/YY)
Time of Birth:---------------------------------------------
Place of Birth:---------------------------------------------
Present Occupation:-------------------------------------
Present Address:------------------------------------------
Phone :------------------------------------------------------
Mobile:------------------------------------------------------
E.Mail:-------------------------------------------------------
Details of the family members:
Name | Relationship | Nakshatra | Rasi |
Details of the contribution:
1.Amount: INR/$/Euro--------------------------------------
2.Mode of payment Cheque/Draft/Money Transfer/Cash/others--------------------------
3.Bank reference:-------------------------------------
4.Date of payment:-----------------------------------
5.PAN.No:-------------------------------------------------
Purpose of payment:
O Donation towards Life Time Patron Programme
O Donation towards:-------------------------------------
Specific Day for the annual puja:---------------------------------
Specific days of visit and stay:------------------------------------
Accommodation required for ----------------------persons for -----------------days.
Signature of the Donor
For office purpose only Receipt No:------------------------- dated----------------------------- Acknowledged by----------------------------------Trustee Approved in the Board Meeting held on-------------------------- Authorized Signatory |