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Forms Paid - Datta T_0056.jpg | Form Type: Donation Form

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General Details

Date DD.MM.YY

Khoji ID

Name

City (Tejasthan / Shahar) *

Zone

Address

Mobile Number

PAN Number

Aadhaar Number

Paid/Unpaid/Partly Paid

Committed Amt

Amount Paid (Cash/Card/Cheque)

Balance Committed Amt

commitment date DD.MM.YY

Donation Items

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Particulars

Option (A/B/C)

Contribution

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Particulars

Option (A/B/C)

Contribution

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Extracted Text

P Khoji ID: मनन आश्रम - सहयोग दान दिनांक : 24/112025 Laxmi m Munigash Ambi १) नाम : तेजस्थान (शहर): सांगली (स्कुर्ती चौका 2) SET: Varindarcen vllas. Icon-s fishrombay, scenglidishcembey, sangles २) पता ५) फोन नं.: ३) पॅन (PAN) :. - OR ४) आधार नं.: मैं मनन आश्रम के लिए धनसेवा करना चाहता/चाहती हूँ। Particulars Required Cost per 10% 1% Selected My Unit Unit Support Support option Contribution MaNaN Ashram Developments Lift for Ambarsthan 2 Nos A) 10 Lakhs B) 2 Lakhs C) 20,000 Tar road to Ambarsthan A) 20 Lakhs B) 2 Lakhs C) 20,000 Stone Steps to Ambarsthan 250 fts A) 10 Lakhs B) 1 Lakhs C) 10,000 One lakh litres Utility water tank 2 nos A) 12 Lakhs B) 2.4 Lakhs C) 24,000 Water Tank for trees / plants watering 2 nos A) 10 Lakhs B) 2 Lakhs C) 20,000 Important Purchases Vehicle Nine seater vehicle - 1 nos A) 15 lakhs B) 1.5 lakhs C) 15,000 Pick up Four wheelers 1 nos A) 15 lakhs B) 1.5 lakhs C) 15,000 Vehicle - Two wheelers 2 nos A) 1 lakhs B) 20,000 C) 2000 C 2000 Laptops 10 nos A) 60,000 B) 60,000 C) 6000 LED TV/Commercial Display 65 inch 5 nos A) 80,000 B) 40,000 C) 4000 For Kitchen-Mixer/Grinder/Juicer/cutter 4 nos A) 50,000 B) 20,000 C) 2000 C 2000- TGF corpus & FD project: [1 lakh] {Yes/No}*. One day food for 100 khoji: [10000] {Yes/No}*. ✓ Donation In Kind: (Grocery, Laptop, Vehicle, Camera,Others: 1-1 Rs 4000/- A) आज कॅश / चेक / कार्ड से दी जानेवाली रक्कम रु. : 5001- B) बाकी रक्कम रु. : 35001- C) बाकी रक्कम देने की तारीख : 151 7 1 2026 Sign A

Extracted Form Fields (JSON)

{
    "fields": {
        "Date DD.MM.YY": "27.12.25",
        "Khoji ID": null,
        "Name": "Laxmi Murgesh Ambi",
        "City (Tejasthan / Shahar)": "Sangli (Skurti Chowk)",
        "Zone": "Sangli Zone",
        "Address": "VRINDAVAN VILLAS, ICON 3, VISHRAMBAG, SANGLI.",
        "Mobile Number": "7798383686",
        "PAN Number": "AXCPA8619E",
        "Aadhaar Number": "6.35903E+11",
        "Paid/Unpaid/Partly Paid": "Partly Paid",
        "Committed Amt": "4000",
        "Amount Paid (Cash/Card/Cheque)": "500",
        "Balance Committed Amt": "3500",
        "commitment date DD.MM.YY": "15.07.26"
    },
    "selected_donations": [
        {
            "particulars": "- Two wheelers",
            "selected_option": "C",
            "my_contribution": 2000
        },
        {
            "particulars": "Kitchen-Mixer/Grinder/Juicer/cutter",
            "selected_option": "C",
            "my_contribution": 2000
        }
    ]
}