My help for the Orissa cyclone affected

I enclose my donation, made payable in Indian Rupees to "Oxfam (India)" for:
Rs. 5,000 Rs. 2,000 Rs. 1,000  Your own amount ...........................
Cheque/Draft No.



Master Card No.
(Sorry, No other cards accepted.)
Valid until - Signature
Name: (Mr./Mrs/Ms/Dr)

Date of Birth Phone Occupation

All donations are exempt under section 80G of the Income Tax Act, 1961

Please print and fill out this form and send it along with your cheque/draft favoring "Oxfam (India)" to:

B-3, Gitanjali Enclave, 2nd Floor, New Delhi 110017. India

Oxfam works with poor people all over India, regardless of race or religion, helping them overcome poverty and inequality to make a lasting improvement in their own lives.

This form has been printed from TheGuide, help site for Indian internet users.