Haridham Donation

First Name of Donor*

Father/Husband Name of Donor*

Surname of Donor*

Full Postal Address*

City*

Pin Code

Email ID

Telephone / Mobile No*

PAN No. of Donor #

Donation Towards*

Donation Scheme*

Donation Type*

Date on which he/she intends to offer Thal/Rasoi/Tithi (dd/mm/yyyy)

Amount of Donation (Rs.) * (Indian Rs.Only) (Minimum of Rs.51)