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| Dear Friends,
You are invited to contribute directly to Mosabbir Cancer Care Centre in Bangladesh , USA or U.K. by filling up the form as under. Please send your Donations or Gifts to the address given below. |
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(BLOCK LETTERS) |
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| Donors' Name: ________________________________________________________________________________ | |||||||||
| Address: ____________________________________________________________________________________ | |||||||||
| ____________________________________________________________________________________ | |||||||||
| Phone no: ___________________________________________________________________________________ | |||||||||
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| A sum of Tk. _________________ (in words) ________________________________________________________ | |||||||||
| Pledge: To donate ( Transport, Ambulance, Medical Equipment, Diagnostic Equipment, Medicines etc. ) Please mention below in detail the donation being given: | |||||||||
_____________________________ Signature of the Donor |
______________________ Date |
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| ---------------------------------------------------------------------------------------------------------------------------- | |||||||||
Thanks for your support |
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| Acknowledgement | Date:______________ |
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| Received with thanks from Ms./ Mr. / Mrs. ____________________________________________________________________________________ | |||||||||
| _________________________________________________________________________________________________________________________________ with gratitude. | |||||||||
_____________________________ Authorised Person On behalf of MCCC |
__________________ Chairman |
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