FCRA Donations Form

Full Name * (required)

Email * (required)

Date of Birth (MM/DD/Year) *

Father’s / Husband’s Name *

Name of the country where staying now *

Status (Work visa/student visa/ Dependent visa etc)-Please specify clearly. *

Occupation*

Name of the Employer *

Employer Address *

Residential Address of donor *

Mobile No. of donor *

Email ID of donor *

PAN card

Aadhar card

Passport/Visa *

Whether holding any one of following Green Card/Permanent Resident/Citizen, if so enclose the image of it. *

My donation remittance details. (Please furnish below the amount in US$/Euros/Pounds etc., and date):

Payment Screenshot *

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