Application Form

1. Name
    Present Postal Address (Block Letters)
                                                                                                                     Pin
2. Date of Birth (if Minor, Minors Guardian)                                                
                                                                                                                     Age
     Father / Mother & Guardian Sri./Smt.
3. House Name & Door No.
4. Telephone
5. Father's / Mother's / Husband's Name
6. Occupation and monthly income/salary
7. Permanent native place, District, Taluk,
     Village, Desam / Kara, Post Office
8. Name of the Nominee / Relationship
    Full Address
9. E-mail ID
    Mobile Number
10. Remited Bank
       Branch
       Date
Gentleman,

Having completely read or caused to be read full understood the rules governing the conduct of the chit herein printed , a copy of which was signed and delivered to you, and which is proposed to be commenced from the.................................................................................day of ...............................................................................and assented the same. I/We send sum of Rs. .................................................(Rupees .............................................................................only) by money order/Cheque/remittance/ in cash less the fixed discount and commission Rs....................... being payment of one ticket valued at Rs. ...........................due for the first instalment. I request you to allot me the ticket

Declaration in the case of minor

The Kuri is joined in the name of my son / daughter and the kuri is subscription from belonging to me and reserve the right to independently
deal with the kuri, its, paid-up subscription or prize money and other benefits attached to the Kuri in whatever manner I like to do.

Yours Faithfully

Our Bankers

South Indian Bank
A/c No. 0030073000050362,
IFS Code: SIBL 0000030
STATE BANK OF INDIA
Ac. No.30838252680
DHANALAKSHMI BANK
Ac. No.0006062000000050
CANARA BANK
Ac. No. 0874201000228
CATHOLIC SYRIAN BANK
Ac. No. 0030-01910208-709001
PUNJAB NATIONAL BANK
Ac. No. 3314002100010311

Our Kuries