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Adopt-a-Cancer-Patient Form

Yes, I want to adopt a patient.

I understand that an approximate cost of Rs. 40,000 (US $ 1,000) is incurred per patient annually. I understand the contribution will be used to totally manage the patient by assisting with the following:

  • Transportation
  • Post surgical rehabilitation
  • Economic support for the patient and family
  • Guidance on spiritual, emotional and psychological problems faced by the entire family
  • Accommodation during treatment
  • Follow up

I understand donations made to CPAA are exempt from Income Tax under Section 80-G of the Income Tax Act (50% tax exemption).

 
I wish to adopt cancer patients.
Please have a representative contact me.

Name:
Title (if any):
Organisation (if any):
Address:
City:
Pincode:
Tel No.:
Fax No.:
E-mail


PAYMENT METHOD

Check the method of payment that you are using

Demand Draft (DD)
Cheque
DD / Cheque Number:
Date:
Issuing Bank:

Please send Stamped receipt and Quarterly Progress Reports to
Address:
Any Other Comments: