DONATION FORM

1. NAME                   :    _____________________________________
2. ADDRESS             :    _____________________________________
3. CONTACT  NO.   :   _____________________________________
4. EMAIL ID.             :   _____________________________________
5. Details of the contributions are to be provided here.....

               CAUSE                                                  AMOUNT
     
   *   Right to vision                      -                         ________
   *   Cataract                              -                         ________
   *   DCT                                   -                         ________
   *   Pterygium                            -                        _________
   *   Spectacles                          -                         _________
   *   For old age home                -                        _________
   *   For orphanage home          -                          _________
   *   Medicines                           -                         _________


NOTE :  For any conundrum you can contact us through our email id. or phone no.