New Chhaya Stores
28 Acharya Prafulla Chandra Roy Road
Kolakata 700 009 Date:
I am hereby remitting Rs .. by cheque/DD no dated
. drawn on .. for me as I belong to
member group 1 (a) /(b)/ (c) and Rs. .. for my family member(s) and the
same does/does not include my Life Membership fees.