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Your Full Name *

Father/ Mother's Name *

Correspondence Address (with Pincode) *

Mobile Number *

10 digit mobile number

Donation Type *

Where would you like this contribution to be spent ?

COVID Fund

Supporting Education a needy

Medical support to needy

Other:

Payment Mode *

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Cheque

Other:

Payment Details *

For NEFT/ IMPS please mention a) UTR number b) Date of membership fee transfer. For Cheque, please mention your Cheque number, date of issue and bank information.

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