To:                                                                                                                                                                     Date:
  Karmayog                                                                                                                                                           Tel: 91 - 22 - 2200 0478
  Shri R.O. Somani Charitable Trust                                                                                                                Fax: 91 - 22 - 2203 5410
  Shreeniwas House, 2nd floor,                                                                                                                        e-mail: info@karmayog.org
  H. Somani Marg, Fort,
  Mumbai 400 001,India.

 a) I am making a donation of Amount: Rs……………..

     By Cheque / Draft in favour of "Shri R. O. Somani Charitable Trust"

        Cheque Number: ……………..                                                                                               Dated: ……………..

        Bank:……………..                                                                                                                      Payable at (Place): ……………..

 b) I am donating towards: (Please select one)
      .  a specific cause, namely ……………..…………….. (please state. e.g. cancer)
      .  any cause selected by Karmayog
      .  Karmayog's own activities (corpus)

 c) Our details are
      . My Name        :
      . Organisation :
      . Address          :
      . City / Town     :
      . Country           : India
      . Phone             :
      . E-mail             :
      . Website          :

 d) Display
      . My Name          O Yes   O No
      . Organisation   O Yes   O No
      . Amount             O Yes   O No