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Registration Form
1. Your Full Name (Full Expanded Name: Initials are not permitted):
Mr.
Mrs.
Miss.
M/s.
Last Name/Surname:
First Name
Middle Name/Corporate Name:
2. Name you would like to get printed on the certificate:
3 (i). Section under which you would like to donate:
- Select Section -
Section 80G
Section 35(1)(ii)/(iii)
Section 35(2AA)
3 (ii). Assessment Year
Select Assessment Year
1-4-2004 To 31-3-2005
1-4-2005 To 31-3-2006
1-4-2006 To 31-3-2007
Status:
Individual
Hindu Undivided Family
Company
Firm
Association of Persons
Body of Individuals
Artificial Juridicial Person
3 (iii). Name of fund to which you would like to donate
4. Donation
- Currency -
$ U.S. Dollar
Euro
Yen
Rupees
Others
Mode
Demand Draft
Cheque
Pay Order
5. Your Father's/Husband's Name:
6.(a) Residential Address:
Flat/Door/Block No.
Name of Premises/Bldg:
Road/Street/Post Office:
Area/Sub Division:
City/District/Town:
State/Union Territory:
Country:
Pin No./Zip Code
6.(b) Official Address:
Office Name:
Flat/Door/Block No.
Name of Premises/Bldg:
Road/Street/Post Office:
Area/Sub Division:
 
City/District/Town:
State/Union Territory:
Country:
Pin No./Zip Code
7. Address for Communication:
- Select Address-
Residential
Official
8. In case of Companies/Partnership Firm/Association of Persons/Hindu Undivided Family/Body of Individuals/Artificial Juridicial Person
Please furnish details about your Management:
(a). Full Name (Full Expanded Name: Initials are not permitted):
Mr.
Mrs.
Miss.
Address
City
Country
Designation:
(b). Full Name (Full Expanded Name: Initials are not permitted):
Mr.
Mrs.
Miss.
Address
City
Country
Specific Details of Donour
ISD Code
Std Code
Number
Telephone No.
Fax No.(If any)
Mobile No.
E-mail ID
Sex: (For Individual applicants only)
Male
Female
Date of event
Birth
Partnership Deed
Registration
Incorporation
Agreement
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Registration Number.
Citizenship/Nationality
Prestigious Occupation
Permanent Account Number.
Income Tax Wards Details: (Optional)
Ward
Circle
Range
Commissioner
Credit Card Details: (If any)
Credit Card No.
Issuing Authority
Particulars of your Bank Account: (If any)
Name of Bank
MICR Code
Account No.
Address of Branch
Declaration:-
I
S/o
D/o
Director of
Partner of
Member of
Promoter of
Authorised officer of
the applicant, do hereby declare that what is stated above is true to the best of my knowledge and belief.
Verified Today
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Place