I AM FIGHTING FOR
ZERO AIDS Related Deaths | New HIV Infections | Stigma & Discrimination
ACKNOWLEDGMENT
Title
THANK YOU FOR SUPPORTING THE FIGHT TO END AIDS Your donation to End AIDS India is liable for 50% tax deduction in India under Section 80G.
First Name
Last Name
THANK YOU We acknowledge the receipt of your donation form. Your donation will bring a smile to the faces of people living with HIV in India. Our PAN for tax exemption purposes is : AABCI2577E. Your rst donation will be debited from your account next month. After this, we will send you a welcome kit with information about how your donation is helping us end AIDS in India. We will also share with you details of our online portal where you can access your donation information and download receipts. If you have any questions please feel free to get in touch with us using any of the channels below: India HIV/AIDS Alliance 6 Community Centre, Zamrudpur, Kailash Colony Extension, New Delhi – 110048 +91-11-4536-7700 | Missed call number: +91-80-3063-6178 | reachus@endaidsindia.org
Thank you for supporting the ď€ ght to END AIDS Your donation to End AIDS India is liable for 50% tax deduction in India under Section 80G.
Title
First Name
DONATION FORM
Last Name
Communication address
Pincode Telephone Number
Mobile Number
Date of Birth D D M M Y Y
E-mail Name on receipt I would like to help children and adults living with HIV in India by donating 1,000 Rs. per month
Signature
Form ID
Fundraiser Signature
Fundraiser Name
Fundraiser ID
Debit Mandate Form NACH / ECS / DIRECT DEBIT UMRN
Date
Tick (ü) ICIC0TREA00 Sponsor Bank Code CREATE INDIA HIV/AIDS ALLIANCE MODIFY I/We hereby authorize CANCEL Bank a/c number
Utility Code
ICICI00261000001992 To debit (Tickü) SB /CA /CC /SB-NRE /SB-NRO /Other
IFSC
with Bank
or MICR
an amount of Rupees FREQUENCY
Mthly
Qtly
H-Yrly
Yrly
As & when presented
Reference 1
DEBIT TYPE
Fixed Amount
Maximum Amount
Phone No.
Reference 2
Email ID I agree for the debit of mandate processing by the bank whom I am authorizing to debit my account as per latest schedule of charges of the bank.
PERIOD From To Or
Until Cancelled
Signature Primary Account holder
Signature of Account holder
Name as in bank records
Name as in bank records
1.
2.
Signature of Account holder
3.
Name as in bank records
This is to confirm that the declaration has been carefully read, understood & made by me/us. I am authorizing the User entity/corporate to debit my account. Based on the instruction as agreed and signed by me. I have understood that I am authorized to cancel/amend this mandate by appropriately communicating the cancellation/amendment request to the user entity/corporate or the bank where I have authorized the debit.
Debit Mandate Form NACH / ECS / DIRECT DEBIT UMRN
Date
Tick (ü) ICIC0TREA00 Sponsor Bank Code CREATE INDIA HIV/AIDS ALLIANCE MODIFY I/We hereby authorize CANCEL Bank a/c number
Utility Code
ICICI00261000001992 To debit (Tickü) SB /CA /CC /SB-NRE /SB-NRO /Other
IFSC
with Bank
or MICR
an amount of Rupees FREQUENCY
Mthly
Qtly
H-Yrly
Yrly
As & when presented
Reference 1
DEBIT TYPE
Fixed Amount
Maximum Amount
Phone No.
Reference 2
Email ID I agree for the debit of mandate processing by the bank whom I am authorizing to debit my account as per latest schedule of charges of the bank.
PERIOD From To Or
Until Cancelled
Signature Primary Account holder
Signature of Account holder
Name as in bank records
Name as in bank records
1.
2.
Signature of Account holder
3.
Name as in bank records
This is to confirm that the declaration has been carefully read, understood & made by me/us. I am authorizing the User entity/corporate to debit my account. Based on the instruction as agreed and signed by me. I have understood that I am authorized to cancel/amend this mandate by appropriately communicating the cancellation/amendment request to the user entity/corporate or the bank where I have authorized the debit.