Bethany Complex, Thrissur Road, Kunnamkulam. Ph : 04885-228566
Name Of Applicant
Name Of the Nominee
Father / Mother / Husband's Name
Details for Documentation
Full adress of the Nominee
Having completely read or caused to be read and fully understood the rules governing the conduct to the chit which is proposed to be started from
and assented to the same, I,hereby remit a sum of Rs.
only ) by cash
being the first instalment of
Numbers ticket of chit No
. I request you to allot me the ticket and I, also hereby agree to any change in the commencement of the chit.
Signature of Subscriber