Smt. Nandini Satpathy Memorial Trust.
hereby certify that all the above-mentioned information is true. I am interested
the Smt. Nandini Satpathy Memorial -Committee for a noble cause
. Kindly find my contribution of Rs.51,000/- (Fifty One Thousand Rupees
DD / Cheque No.
am aware of the aims & objectives of Smt. Nandini Satpathy Memorial Trust
. I am also
aware of the rules & regulations of the said trust. I pledge
to abide by them.
two self-attested current dated photographs of self, spouse and dependent
children along with this application form.
/ DD to be made in favor of "Smt.Nandini Satpathy Memorial Trust"
fax the copy of this application form (duly filled) along with the copy of
DD / Cheque to fax no. +91.674.253.6262. On approval of your application
of the same will be collected from you in person.(Please do
not send payment in advance)
you can submit this form online.