JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Donor information - Indian donors
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.
Sign in to Google
to save your progress.
Learn more
* Required
Full Name
*
Please enter your full name.
Your answer
Email ID
*
A soft copy of the receipt will be sent to this email ID.
Your answer
Receive email updates?
Check this box if you agree to receive activity updates and event notifications by email from Samiksha Foundation.
Phone number
*
Your answer
How much do you plan to donate?
*
Please enter the amount in Indian Rupees (INR).
Your answer
PAN
If you are donating more than Rs. 5000, please enter your Permanent Account Number (PAN). This is required for issuing an 80G receipt.
Your answer
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.
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
Forms
This form was created inside of Samiksha Foundation.
Report Abuse
Terms of Service
Privacy Policy