ActionAid Form

Change begins with

Children Ending in justice . in equality . in humanity

ACKNOWLEDGMENT

Title

Thank You For Joining The ActionAid Family

Donations to ActionAid are exempt from 50% tax under section 80G of the Income Tax Act.

First Name

Donation Amount

Last Name Donation Frequency

THANK YOU We acknowledge the receipt of your donation form. Your donation will help marginalised children access nutrition, healthcare and quality education. Our PAN for tax exemption purposes is : AAAAA9409Q. Your first donation will be debited within the next 30 days. We will send you a consolidated receipt and tax exemption certificate once every year.

Please note : ActionAid does not ask for/ accept cash donations.

If you have any questions, please feel free to get in touch with us using any of the channels below: Supporter Services Unit, ActionAid Association, 139, Richmond Road, Bangalore - 560 025 Country Office, ActionAid Association, R7, Hauz Khas Enclave, New Delhi - 110016 Website : www.actionaidindia.org | E-Mail : fundindia@actionaid.org | Tel : +91-80-25586293 | 180030701017 (Toll-free)

Thank You For Joining The ActionAid Family

Donations to ActionAid are exempt from 50% tax under section 80G of the Income Tax Act.

Title

First Name

DONATION FORM

Last Name

Communication address Pincode Telephone Number

Mobile Number

Date of Birth

E-mail Name on receipt

PAN No.

I would like to support marginalised children

Signature

D D M M Y Y

Debit Mandate Form NACH / ECS / DIRECT DEBIT UMRN Tick (ü)

Date

SBIN0001308

Sponsor Bank Code

CREATE MODIFY CANCEL

Utility Code

I/We hereby authorize ActionAid Association

NACH00000000022869 To debit (Tickü) SB /CA /CC /SB-NRE /SB-NRO /Other

Bank a/c number

IFSC

with Bank

or MICR

an amount of Rupees FREQUENCY

Mthly

Qtly

H-Yrly

Yrly

As & when presented

Reference 1

Fixed Amount

Maximum Amount

Phone No.

Reference 2 PERIOD

DEBIT TYPE

Email ID I agree for the debit of mandate processing charges by the bank whom I am authorizing to debit my account as per latest schedule of charges of the bank.

From To Or

ü Until Cancelled

Signature Primary Account holder

Signature of Account holder

Name as in bank records

Name as in bank records

1.

2.

Signature of Account holder

3.

Name as in bank records

This is to conrm that the declaration has been carefully read, understood & made by me/us. I am authorizing the User entity/corporate to debit my account. Based on the instruction as agreed and signed by me.

I have understood that I am authorized to cancel/amend this mandate by appropriately communicating the cancellation/amendment request to the user entity/corporate or the bank where I have authorized the debit.

Form ID

Fundraiser Signature

Fundraiser Name

Fundraiser ID

Debit Mandate Form NACH / ECS / DIRECT DEBIT UMRN Tick (ü)

Date

SBIN0001308

Sponsor Bank Code

CREATE MODIFY CANCEL

Utility Code

I/We hereby authorize ActionAid Association

NACH00000000022869 To debit (Tickü) SB /CA /CC /SB-NRE /SB-NRO /Other

Bank a/c number

IFSC

with Bank

or MICR

an amount of Rupees FREQUENCY

Mthly

Qtly

H-Yrly

Yrly

As & when presented

Reference 1

Fixed Amount

Maximum Amount

Phone No.

Reference 2 PERIOD

DEBIT TYPE

Email ID I agree for the debit of mandate processing charges by the bank whom I am authorizing to debit my account as per latest schedule of charges of the bank.

From To Or

ü Until Cancelled

Signature Primary Account holder

Signature of Account holder

Name as in bank records

Name as in bank records

1.

2.

Signature of Account holder

3.

Name as in bank records

This is to conrm that the declaration has been carefully read, understood & made by me/us. I am authorizing the User entity/corporate to debit my account. Based on the instruction as agreed and signed by me.

I have understood that I am authorized to cancel/amend this mandate by appropriately communicating the cancellation/amendment request to the user entity/corporate or the bank where I have authorized the debit.

Form ID

Fundraiser Signature

Fundraiser Name

Fundraiser ID