Contribute - How you can help - Travel Assistance Form

Travel Assistance Form

Yes, I would like to help a patient with travel assistance.

I would like to make a donation. I understand donations made to CPAA are exempt from Income Tax under Section 80-G of the Income Tax Act (50% tax exemption).

I want to make a donation of my frequent flyer miles. Please have a representative contact me.

Name:
Title (if any):
Organisation (if any):
Address:
City:
Pincode:
Tel No.:
Fax No.:
E-mail

PAYMENT METHOD
Check the method of payment that you are using
Demand Draft (DD)
Cheque

DD / Cheque Number:
Date:
Issuing Bank:

Please send Stamped receipt for the donation to
Address:
Any Other Comments: