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..