AGA KHAN FOUNDATION (PAKISTAN)
Form#

DIAMOND JUBILEE NAZRANA
NIYAT FORM


Participant ID / Account No. Region
Jamatkhana Centre City

1. PARTICIPANT INFORMATION (All Caps)
Corporation Name (if contribution is being made by a corporation)
NTN – In case of Corporation (Kindly provide copy)
Participant: Mr. Mrs. Mr. & Mrs. Ms. Dr. Dr. & Mrs. Dr. & Mr.
Surname / Last Name
First Name
Spouse’s Surname / Last Name
First Name
Address
City
Province
Country
CNIC (Kindly provide copy)
Email Address

2. NIYAT INFORMATION (All Caps)
I/We understand that the Niyat is being made on an unconditional basis.
Niyat Amount
Currency
Niyat Date
Amount in words:

I/We would like to offer the Niyat in the name of an individual stated below:


3. FREQUENCY AND METHOD OF OFFERING
Frequency of Payment
Lump sum Installments:
No. of Installments:   No. of Installments:
Method of Payment
Cheque   Full / Initial Payment: Interim Receipt No.
Note: AKF (Pakistan) will only issue donation receipt in the name of the account holder (name appearing on cheque).

4. SIGNATURE
Participant’s Name: Signature: Date:
AKF (Pakistan) will comply with all legislative requirements i n protecting your personal information. AKF ( Pakistan) will o nly disclose information if required by law. AKF (Pakistan) will share information with its affiliated organization jointly invo lved i n this endeavor
For Internal Use Only Name Signature Date
Committee Member
Jamati Coordinator
AKF,P (Received by)