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Aid for Special Investigation Form

Yes, I would like to make a contribution towards a special investigation for a patient.

  • Mammography @ Rs 1,500 (US $ 50)
  • CT Scan @ Rs 6,000 (US $ 200)
  • MRI @ Rs 9,000 (US $ 300)
  • Radiation @ Rs 15,000 (US $ 500)

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

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: