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Primer Order Form for Swabhiman

Category * :
District * :
Name of person ordering * :
Address * :
City * :
State * :
Pin * :
Mobile No * :
Email * :
Designation * :
Name of Club * :
Name of School * :
City * :
Pin Code * :
Address where toolkits are to be sent (Preferably of the person who is ordering)
Address * :
City * :
State * :
Pin * :
Toolkits required (Minimum 50 or in multiples of 50 per language)
LanguageNumber RequiredTotal Cost
Bangla
Gujarati
Hindi
Kannada
Marathi
Odia
Telugu
Grand Total
Total amount to be paid * :
Note :- Payment by Demand Draft / Pay Order / Cheque / RTGS payable at Kolkata has to be made in favour of “RSAS A/C Literacy Mission” and to be sent by Courier / Speed Post to Rotary India Literacy Mission – 145, Sarat Bose Road, Kolkata – 700026.

For RTGS :
Name: RSAS A/C Literacy Mission.
Account Number: 037201003120.
Bank: Icici Bank.
Ifsc: ICIC0000372.
Branch: 95, sarat bose road, kolkata 700026.
In case of RTGS, NEFT please email us the scanned copy of the bank slip along with a cover letter to admin@rotaryteach.org
 
DD / Pay Order No. / Cheque / RTGS No. :
Amount :
Date :
Bank Name :
Attach Scanned copy of DD / Pay Order / Cheque / RTGS No. :
Attach Scanned copy of Filled up School Commitment Form [Attach image files only(jpg/gif)]* :