Thursday 17 November 2011

Application for Donors – Life Time Patron Programme

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



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