Date

I / We wish to donate a sum of Rupee ( )

Cheque / Demand Draft Number :

Drawn on Bank:

100% Tax Exemption u/s 35 (i) ii wanted :
Yes No

Signature ________________________________________

Name :

Phone No. :

FAX no. :

Email Address :

You wish to donate on a yearly basis?
Yes No

Would you like to receive regular activity reports of BTF?
Yes No