Asha Bhavan Centre

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DISABLED CHILD SPONSOR FORM

Your selected child details are as follows.

Name:

Tumpa Singha Roy

Dob:

10/01/93

Age:

Gender:

Female

Disability:

Deprived of Family

Her desire to regain the dignity in society is appreciable. Tumpa with her brother and sister are deprived of the love and affection of their parents. Their father is a fraud and mother is missing for a long time. So they had nobody to take care. They were brought to Asha Bhavan by the community people.


PLEASE CHOOSE THE TYPE OF SPONSORSHIP

		for 1 year.
		for life time(18 years).
Your Sponsorship Amount will be used for cure and care of your selected child for the respective time.

Your Donations are tax exempted u/s 80(g)

PLEASE GIVE YOUR PARTICULARS HERE

Name in Full

Address

Phone Number Work

Fax Number

Phone Number Home

Mobile Phone Number

Email ID

Age

Gender

Male

Female

Spouse's Name(if any)

Number of Children(if any)

Girl(s)

Boy(s)

Any special comments/Suggestions

PLEASE GIVE YOUR PAYMENT DETAILS


Cheque/DD No.	:
Dated	:
on Bank	:	Favouring Asha Bhavan Centre payable at Kolkata.