To

Subhas Chatterjee

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.

Brotherly yours,

Name:

Batch:

Address:

Pin: