Wecare Family Health Scheme Charitable Trust (WFHS)

Age:

Date of Birth:

Gender / Sex

Male

Female

WFHS Health Card NO:

WFHS Marketing Executive Name:

WFHS Marketing Executive ID No:

Type of Health Card: Silver Gold Platinum

Address of person making donation :

Pin code :

State/type :

Landline / Telephone No :

Mobile / Whats App :

Email ID :

Number of meals :

Donation amount :

Method of donation : only through bank in Indian Rupees. No cash transaction allowed

Pravasies donation for One Dialysis Kit Rs.100/- must be in Indian Rupees from NRE or NRO account only. (Foreign Currency is not accepted)

Whom to contact for making donation : Local/Gulf/Other countries marketing executive/ WFHS office

PLEASE DONATE ONE MEAL AND SAVE HUNGER