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Donor Registration Form :


Registration Form for donations made by Cheque/DD/Pay Order

Name
 
Organization Name
 
Address
 
Phone
 
Mobile
 
Fax
 
Email
 
Please accept my donation of Rs.
 
Purpose of Donation
Permanent Account Number
(PAN) (mandatory for donation
above Rs. 50,000)
 
Mode of Payment:

Details for Wire Remittance:

Account No.

:  910010033575620

Name of Account

:  DR. RATHOD MEDICAL FOUNDATION

Name of The Bank

:  Axis Bank Limited

Address of The Beneficiary Bank

:  87 Atur House, Dr. Annie Besant Road,
   Worli, Mumbai - 400018, India

IFS Code

:  UTIB0000653

MICR NO

:  400211054


For Cheque/Demand Draft:

Name of Account

:   DR. RATHOD MEDICAL FOUNDATION

Mailing Address:

:   World Gastroenterology Institute,
    Amboli Naka Signal,
    Next to ICICI Prudential,
    Main S.V.Road,Andheri (West),
    Mumbai - 400058, India