IAD HAS NO BRANCHES OUTSIDE KASARAGOD KERALA
PurposeSponsorship for treatmentGeneral SponsorshipInfra Structure/building fund
Date ( YYYY-MM-DD)
Mode Of PaymentChequeDDBank TransferNEFT
Chq/DD No.
Chq/DD Date
Bank Name
Land Phone
Mobile
Cheque/DD If you wish to do the contribution by chq/DD please print this form and send along with the Chq/DD to the following postal address
Institute of Applied Dermatology #MP XVI/575(A) IAD junction, Uliyathadka, Madhur Road, Kasaragod 671124 Phone : 04994-240862, 240863, Email : iadorg@gmail.com Web : www.iad.org.in
Bank transfer Thank you for contributing to IAD. Once the amount credited in our bank account we will send the receipt. Please mention your name pay in slip