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EWA Charitable Trust

No: 1/50 Sivan Kovil South Street, 2nd Floor, Kodambakkam,


Chennai - 600 024, Phone: 044 24727472, Mobile: 9444117472,
Email: ewacharitabletrust@gmail.com, Web: www.ewacharitable.org (Reg.)

Volunteer Name :
.........................................................................................Code:...............................................

DONORS DETAILS
Donor Name:

Gender: Male / Female

Mr./ Mrs. .................................................................................. DOB : ........./......../..................


Spouse Name :Gender: Male / Female
Mr./ Mrs. .................................................................................. DOB : ........./......../..................
Children Name :1)................................................................ 2)............................................................................
M / F DOB : ........./.........../.......... M / F DOB : ........./........../..........
Address : .................................................................................................................................
...................................................................................................................................................
...................................................................................................................................................
City................................................................. Pin....................................................................
Mobile No : .............................................. Phone : .................................................................
Email : ......................................................................................................................................
Temporary Receipt
Received with thanks from Mr / Mrs .......................................................................................
by Cheque / D.D. No..............................dated...../......../.........., drawn on ..............................
for the sum of Rs.......................................................................................................................

Note : The receipt is subject to acceptance and subsequent realization of cheque

Cheque / D.D. to be made in favour of EWA CHARITABLE TRUST

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