Form for payment through Credit Cards
Name :
________________________________________________
(
As it appears on the credit card)
Address : ______________________________________________
PIN ________________ Country ___________________
Phone ______________ (Off)__________________(Res)
Card : Diners / MasterCard / VISA /
AMEX
Card No. : - - - - - - - - - - - - - - - -
Expiry Date : - - / - - - -
MM YYYY
Amount : Rs -- US$-- Euro--
GBP-- ..........................
Currency
Amount
Amount in Words : _____________________________________________________
Date of Birth : - - - - - - - -
of Card Holder DD MM YYYY
Email Address : ________________________
Please make this donation to the Prime Minister's National Relief Fund. I
will at no stage dispute this donation and I confirm that this Credit Card
belongs to me.
______________________
Signature
(As it appears on credit card).
Card holders either mail this slip to the PMNRF, Prime Minister's Office,
New Delhi 110011 or Fax this slip to FAX nos. 91-11-23016857, 91-11-23019545,
91-44-28525769.
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Form for payment through Cheques & Drafts
Cheque /Draft No : ____________________
Bank Name : ____________Branch :_________
Amount : _________ Amount in Words : ___________________________________
Kindly mail your Cheques / Drafts along with this slip to the PMNRF,
Prime Minister's Office, New Delhi 110011.
All donations are 100% exempt under Indian Income Tax Act
Receipt for donations received shall be sent by Post..
