ActionAid Association, Supporters Service Unit, #139, Richmond Road, Bangalore-560 025

Phone: +91-80-25586293, Website:www.actionaid.org/india, E-mail: fundindia@actionaid.org

Contribution to ActionAid Association is exempted from Tax under Section 80G of Income Tax Act 1961.
Yes, I would like to Sponsor a Child.!
I would like to sponsor : 10 Children 5 Children 3 Children 2 Children 1 Child Others ....................................................
Payment Frequency : 600/Month 1800/Quarterly 3600/Half Yearly 7200/Annually

Personal details to know you better There are three different ways of donating
PLEASE COMPLETE IN BLOCK LETTERS 1. Credit Cards
2. Cheque/DD
3. Direct Debit
(Mr/Mrs/Ms) ................................................................................................................... Gender: Male Female Third gender or ACH
(Full Name)
Address: .................................................................................................................................................................................................................................
................................................................................................................................................................................... Pin. ......................................................
Mobile: (Off.) ......................................... (Per.)......................................... Phone: (Off.) ...................................... (Res.). ............................................
e-mail: (Off.).................................................................................................... (Per.) ...........................................................................................................
dd mm yy
Date of Birth: .............../ .................../ .................. PAN: ........................................................................................ (to help issue 80G certificate)
Profession: Company:

1. I prefer to make my gift through CREDIT CARD 2. I prefer to make my gift by CHEQUE/DD
My Credit Card Details:
.................... No. of post dated cheques for child sponsorship
Name of the Bank: ..................................................................................................
payable to ActionAid Association.
Visa Mastercard Number:
My Cheque/DD for one-time donation of ............................
payable to ActionAid Association.
Name as on card: .....................................................................................................
Cheque/DD No.: ....................................... Dated :.......... /........... /..........

Attn: CASH Donation are NOT Accepted

Date of Birth (dd/mm/yy) : ......................... Expiry Date: .............................
(Payable to ActionAid Association).
Signature: ................................................................................................................
I authorise quarterly/half-yearly/annual deductions of Drawee Bank: .............................................
.............from my Credit Card beginning from ........./ ........./ ...........
until further written notice from me. Signature

3. I prefer to authorise donation payments through Direct Debits from my bank account through AUTOMATED CLEARING HOUSE (ACH).
Please fill the below form to sign up for ACH and ensure an uninterupted support for your child.
*Direct Debit will start in the nextavailable month