sensee

International
PLEASE FILL THE FORM IN CAPITAL LETTERS INDIA
Working with deafblind piople

Cheque/Bank draft Please make your cheque in favour of Sense International India
Do not give any cash payments
Bank name:

Branch: MICR no:

City:

Cheque no: Amount: Cheque Date:

DD MMYYYY
Amount in words:

Your contribution will enable children with deafblindness to discover the world around them.
I would like to donate:
5,000 provides one deafblind child, specialised learning material and toys essential for development.
7,000 to help a deafblind child acquire mobility using assistive devices.
9,000 to sponsor a deablind childs nutritional and medical requirements for three months.
10,000 to help a deafblind child and parent learn sign language to communicate and share their joy.
Other ********************** (Any amount you wish to contribute that would go to help a deafblind child.)

Date: ****************** Donors signature: ***************************************************

*For timely tax receipts, please provide us with your email id

(Kindlycompleteandretain thistemporary receipt for your ownreference)

ECEIPTNO: SI 037213
No
Date:

Received with gratitude from Mr/Ms/Dr .

the sum of Rupees. **enrneeensesnoonsprsesspepessspossssp**** **** ************* . by Cheque/Bank draft.

drawn on. ************* s dated ****************** ************************************* for Sense International India.
Please Note: This is a temporary receipt. A formal receipt will be sent by Sense International India within 30 working days.
50% exemption u/s 80G@ of Income Tax Act,1961 subject to receipt of PAN. We will also send you regular communication
of how your donation is bringing joy.
***** * * * * * * * e * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

Signature (Sense International India representative)

Sense International India is registered under the Bombay Public Trust Act 1950: E/11279/Ahmedabad
PAN: AA AA S3015 Q Please contact us:
Sense International India
Andhjan Mandal Campus, Vastrapur, Ahmedabad 380 015 Phone: +91 79 26301282
info@senseintindia.org I www.senseintindia.org I www.facebook.com/discoversense I Deafblind Helpline: 1800233 7913
 sense
International
INDIA
PLEASE FILL THE FORM IN CAPITAL LETTERS Worhing wth deafbylind people

Donor form no: SI N 037213 MrMsDrMIs

Donor name: (mention name as needed in receipt) First name Date of birth:

Last/Family name Anniversary date:

DDMMYYY
Contact address:

City: State:

Pin code: Telephone (Residence/Office):

Mobile: PAN no: (essential for availing tax exemption)

Email: (Help save the environment by providing your e-mail id! Tax receipts sent through email saves paper.)

Name of Organisation/Company/Trust: Designation and Department:

Feedback: Iwant to volunteer with Sense

International India
DF-501-18

We at Sense International India, also known as Sense India, support and advocate for children and
adults with deafblindness across ndia, We partner with NGOs and the government to provide care,
education and to advocate for better services for the cause of deafblindness.

Deafblindness is a multi-sensory impairment where children and adults have a combination of vision
and hearing loss. This deeply affects their mobility, communication, learning and understanding of
our world, Though this is not a common disability, India has an estimated 500,000 children and
adults with deafblindness

We began work in 1997, At that time, throughout India, only 23 deafblind children were receiving
services, Today, through Sense Indias support, we reach out to 77,500+ children and adults with
deafblindness through:
direct care to over 14,000 children vwith deafblindness and multi-sensory impairments
partnership with the government, reaching out to 63,500+ children with deafblindness
through government schools
training 3,815 teachers with speci t skills required to teach children with deafblindness
vocational training to young adults with deafblindness
creating networks of deafblind adults, parents of deafblind children and teachers to serve
deafblind children better.

Our goal is to reach out to 50,000 more children and adults with deafblindness over the next three
years and for this we seek support from individuals like you. On behalf of all of us at Sense India, we
thank you for your support.