IAD HAS NO BRANCHES OUTSIDE KASARAGOD KERALA

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Home Donation

Donations Form

    Name and Address to be mentioned in the receipt
    Donor Name (required)

    House Name

    Street

    City (required)

    State

    Country

    Pin

    Amount in figure Rs:

    Amount In words Rs:

    Purpose

    Date ( YYYY-MM-DD)

    Mode of Payment

    Chq/DD No.

    Chq/DD Date

    Bank Name

    Land Phone

    Mobile

    Personal Email(required)

    Official Email (required)

    Note:

    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

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