o PLEASE MARK THIS SKS NO.

IN SYSTEM
SHREE SAMAST KHADAYATA SURKSHA TRUST DFC Notice No. 20
Regd. Office : Shreeji Hospital, Opp Brij Nagar, Station Road, Ankleshwar-393 001-Ph. (02646) 221411 +ÉLÉù lÉÉùÒLÉ / Last Date
28-02-12
Trust A/c. No. in Bank
(Bank’s Copy)

A
Advance DFC ADFC Member Amount Balance
DFC Amount Contribution Payable

1280 250 40
20

Payment of Rs. made by Cash / Cheque / DD by No. Receiving

dtd. in BOB/KOTAK/IDBI Branch Bank’s Sign,
Date,Seal
Signature of Depositor

SHREE SAMAST KHADAYATA SURKSHA TRUST DFC Notice No. 20

(Bank to send this copy with monthly statement /

Regd. Office : Shreeji Hospital, Opp Brij Nagar, Station Road, Ankleshwar-393 001-Ph. (02646) 221411
+ÉLÉù lÉÉùÒLÉ / Last Date
o Please mark this SKS No. in system 28-02-12
Trust A/c. No. in Bank
MT to Ankleshwar)

Member Amount Balance

B
Advance DFC ADFC
DFC Amount Contribution Payable

1280 250 40
20

Payment of Rs. made by Cash / Cheque / DD by No. Receiving

dtd. in BOB/KOTAK/IDBI Branch Bank’s Sign,
Date,Seal
Signature of Depositor

SHREE SAMAST KHADAYATA SURKSHA TRUST DFC Notice No. 20

Regd. Office : Shreeji Hospital, Opp Brij Nagar, Station Road, Ankleshwar-393 001-Ph. (02646) 221411
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+ÉLÉù lÉÉùÒLÉ / Last Date

28-02-12
Trust A/c. No. in Bank

C
Advance DFC ADFC Member Amount Balance
DFC Amount Contribution Payable

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20
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Bank’s Sign,
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SHREE SAMAST KHADAYATA SURKSHA TRUST DFC Notice No. 20

Regd. Office : Shreeji Hospital, Opp Brij Nagar, Station Road, Ankleshwar-393 001-Ph. (02646) 221411 +ÉLÉù lÉÉùÒLÉ / Last Date
(Member’s Copy ) (»É§«É+à HÉ«É©É ©ÉÉ÷à

28-02-12
Trust A/c. No. in Bank
X³´ÉÒ ùÉLÉ´ÉÉ{ÉÒ HÉà~ÉÒ)

Member Amount Balance

D
Advance DFC ADFC
DFC Amount Contribution Payable

1280 250 40
20

°É. ±ÉÉàH±É SÉàH/eÒ.eÒ./ùÉàHeÉ ¥ÉáH{ÉÉ ¶ÉÉLÉÉ, Receiving

Bank’s Sign,
~Éù{ÉÉ SÉàH/eÒ.eÒ. {ÉÅ¥Éù wÉùÉ BOB/KOTAK/IDBI {ÉÒ ¶ÉÉLÉÉ©ÉÉÅ Date,Seal
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