DATE: General Manager. IG MINT HYDERABAD. Rs 10. Rs 5. 1. 150th of Birth Anniversary of Madan Mohan Malaviya. 312/-. 2.
ORDER FORM TO, General Manager IG MINT HYDERABAD
DATE:
Please book my order for commemorative coin as per the following information:
Sno
Name of the single coin
ORDER FORM FOR SINGLE COIN Denomination of Coin(Amount specified for each coin)
Rs 10 1 2 3 4 5 6
150th of Birth Anniversary of Madan Mohan Malaviya 150 Years of Kuka Movement 150th Birth Anniversary of Motilal Nehru
Total cost of ordered coins
Rs 5 312/312/312/-
360/-
60 Years of Coir Board
coins required
312/312/-
60 Years of India Government Mint Kolkata 150th Birth Anniversary of Swami Vivekananda
TOTAL AMOUNT
Above amount is sent herewith by D.D for Rs. /- drawn in favour of “INDIA GOVERNMENT MINT, HYDERABAD (A UNIT OF SPMCIL) by D.D. No.--------dated drawn ------------------------------(name of the bank and branch). The DD may be sent by Registered Post/Ack. Due only. The Envelop must be super scribed as “Application For Commemorative Coins”. Name and Postal Address : Name(full in capital) DIST
. State :
. Postal Address: H.No : Pin code :
, Street Phone No:…………………......
email id : Note :
One DD can be taken for total booking along with the order form.
