Paid Contributions to ACT Form

Form To Confirm Paid Contributions To ACT

Yearly Contribution,
Patron
Endowment Fund

PERSONS WHO MADE CONTRIBUTIONS are requested to FILL UP this FORM giving mode of ACTUAL PAYMENT TO ACT. Receipt will be sent to you as soon as payment realised

Name(Required)

Prefix First Last

Present Address(Required)

Door No & Street Village / Nagar Local Area City State / Province / Region PIN Code Country

Email(Required)

Phone(Required)

Contributor's PAN(Required)

Options To Contribute(Required)

ACT Member Annual Contribution ₹2,500

ACT Patron ₹50,000

Endowment Fund in ACT ₹1,25,000

Amount to be filled by me

Amount Paid(Required)

Input Contribution Detail(Required)

1. Amount Contributed
2. Specify Purpose of Contribution
3. Inut Your Mode of Payment like UPI/NEFT/Cheque. Input UTR No. OR Cheque No. & Date, Bank Name & Branch

Declare