Donor information - Indian donors

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Thank you for choosing to donate to Samiksha Foundation.
Please complete this form before making a donation via NEFT or cheque.
This helps us process your donation correctly and quickly.

Full Name *

Please enter your full name.

Email ID *

A soft copy of the receipt will be sent to this email ID.

Receive email updates?

Check this box if you agree to receive activity updates and event notifications by email from Samiksha Foundation.

Phone number *

How much do you plan to donate? *

Please enter the amount in Indian Rupees (INR).

PAN

If you are donating more than Rs. 5000, please enter your Permanent Account Number (PAN). This is required for issuing an 80G receipt.

Mailing Address

The receipt will be emailed after payment. If you would like to receive a hard copy of the receipt, please provide your full address here. Leave blank if you do not want a hard copy.

Submit

Clear form

Never submit passwords through Google Forms.

Forms

This form was created inside of Samiksha Foundation.