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ROTARY INT E, RAIAT I O T,{AL RE C E I!!

Rotary'ffi Fiscal Agency of BANGLADE,SH


Country

Disrrict - oV@E E lTl no,*v crub ID o EEEEE EreEm f E


E EIEEE Individual ro + I-r-IEEEEEEEEEE
@a^Ll@at,il Receipt Number
ffir"Copy
g.6""Copy
to Club/lndividual
for Fiscal Agent Files rr [q-l .r-T
I ory' llMonth ll Year I

Date of ReceiPt

ReceivedFrom , DHaLA N tWforrt{ ..


l@ -
n RotaractClub Elndlvidual
through btto' 2 h
In payment of the following items incured during the periot

Local Currency B US$

09652^qY each (55'61


q' Lo
ClubDues(InvoiceNo) @@
Charter Fee (New Club)

The Rotary Foundation Contributions each

each
Others r

Remittance accepted at exchange rete :

rorAl fst6t?^
BDr ll;E;Fl Per $ 1.oo US GRAND

Remarks/Special lnstruction : Received DD/PO/Cash/Che{ue #


t[ , t(. z b q+N -
I
6, A u- fi& Bank which is

deposited to A/C # 0003 O2tOOl3zdA t Wnd Trust Bank Ltd., Bangladesh.

Payment Received bY :

Office Assistant Fiscal Agent)

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