Wecare Family Health Scheme Charitable Trust (WFHS)

COST OF ONE DIALYSIS KIT: RS.1,500

DONATING NUMBER :

COST OF ONE DIALYSIS MACHINE: RS.7,50,000

DONATING NUMBER :

COST OF AV FISTULA SURGERY: RS.15,000

DONATING NUMBER :

COST OF ONE MEAL: RS.150

DONATING NUMBER :

SPARE AN AMOUNT FROM YOUR FAMILY BIRTHDAY, MARRIAGE, ANNIVERSARY PARTIES, PICNIC, TOURS, GET TOGETHER FUNCTIONS AND DONATE AND SAVE LIFE AND HUNGER.WHILE MAKING DONATION PLEASE PROVIDE PANCARD DETAILS. ALL DONATIONS THROUGH BANK ONLY. NO CASH DONATION EXCEPT AT WFHS OFFICE. PRAVASIES DONATION FROM NRE/NRO INDIAN RUPEE ACCOUNT ONLY. FOREIGN CURRENCY DONATION NOT ACCEPTED.

TOTAL AMOUNT OF DONATION: RS

Name of the person/Organization making donation :

Age:

Date of Birth:

Nationality:

Photo Id Number:

ANY ONE OF THE FOLLOWING PHOTO ID NUMBER: AADHAR CARD PANCARD PASSPORT OCI CARD VOTERS ID DRIVING LICENSE

Address Of Person / Organization : :

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Mobile / Whats App :

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Name of Beneficiary :

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Bank Name :

Branch Name :

Place of Bank :

IFSC code No :

Amount transferred to indian rupees: Rs.

Amount in words:

Name of Remitter :

A/C Number :

Bank Name :

Branch Name :

Place of Bank :

IFSC code No :

Amount transferred : Rs.

Amount in words:

RECEIPT WILL BE SEND TO YOUR ADDRESS BY POST/E-MAIL

ANY DOUBTS REGARDING OFFERING DONATION,PLEASE CONTACT OUR MARKETING EXECUTIVES OR WFHS OFFICE. FILLED APPLICATION FOR DONATION OF DIALYSIS KIT/DIALYSIS MACHINE/AV FISTULA SURGERY/ONE MEAL MUST BE FORWARD TO WFHS OFFICE BY POST/COURIER/ONLINE/E-MAIL

Place:

Name of Person Offering donation:

Date:

Signature:

File:

DONATION OF DIALYSIS KIT/DIALYSIS MACHINE/AV FISTULA SURGERY/ONE DAY ONE MEAL

ONLINE APPLICATION FORM FOR DONATION OF DIALYSIS KIT/DIALYSIS MACHINE/AV FISTULA SURGERY/ONE DAY ONE MEAL

COST OF ONE DIALYSIS KIT RS.1500/- (ONE THOUSAND FIVE HUNDRED RUPEES ONLY)

RECEIPT WILL BE SEND TO YOUR ADDRESS BY POST/E-MAIL

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