The
Chairman,
Smt. Nandini Satpathy Memorial Trust.
Sundarikhal, Dhenkanal,
Orissa, India
Sir,
I
hereby certify that all the above-mentioned information is true. I am interested
in joining
the Smt. Nandini Satpathy Memorial -Committee for a noble cause
. Kindly find my contribution of Rs.51,000/- (Fifty One Thousand Rupees
Only)
DD / Cheque No.
Dated
Bank
Branch
I
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.
Signatures
Name
Date
Member
Reference :Name
Note:
-
|
|
i. |
Attach
two self-attested current dated photographs of self, spouse and dependent
children along with this application form. |
ii. |
Cheque
/ DD to be made in favor of "Smt.Nandini Satpathy Memorial Trust" |
iii. |
Kindly
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
the originals
of the same will be collected from you in person.(Please do
not send payment in advance) |
iv. |
Optionally
you can submit this form online. |
|