Document to Accompany Donations made to CoviScience@ACTREC (donation for charity)

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https://actrec.gov.in/coviscienceactrec Your donation via QR code, through bank transfer or cheque will be considered complete after submission of this form. Please write to CoviScienceACTREC@gmail.com for queries.

Email *

Name of the donor *

Phone No. (mobile) of the donor *

Email id of the donor *

Donation made by *

Cheque or Bank draft addressed to "Director ACTREC- Tata Memorial Centre” payable to Advanced Centre For Treatment Research & Education In Cancer (ACTREC), Tata Memorial Centre ACTREC, Sector 22, Kharghar, Navi Mumbai-410210, India. Cheques drawn in any major international currency from any bank may be mailed to the same address. Please include a print copy of this form along with the cheque.

Through Online Bank transfer

Through UPI by scanning our QR code

Other:

Amount of donation (with currency): *

Please mention your bank name, and details or UPI (through QR code) transaction reference number for donations made within India. International donors, please indicate the name of your bank initiating the transfer or your cheque details :

Whether tax exemption certificate is required? (Donations made to ACTREC-Tata Memorial Centre within India are tax exempt u/s 80G of Indian Tax rules). International donors may skip this section.

Yes

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PAN Number of the donor. (International donors may skip this section):

I confirm that the amount donated to the CoviScience@ACTREC (donation for charity) can be used in an unrestricted way at the discretion of the Director ACTREC for COVID-related treatment, diagnostics, and to help facilitate a mass vaccination program for the under privilege at ACTREC- Tata Memorial Centre. *

Yes

Send me a copy of my responses.

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