Name:
Address:
E-mail address:
Remittance details: Draft/Cheque No.           dt.
Certified that the amount is for the use of Samratchana Trust for any 
of its activities.

Date:                           Signature:

_____________________________________________________________________
FOR OFFICIAL USE:
Sl No.
Receipt no.& date:
Advised for e-mail on:
E-mail allotted on:
                        Initials of Accounts Dept