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Yes I believe in empowering the underprivileged by restoring/improving their eye sight!
I would like to donate a sum of Rs……………………… to support the sight restoring activities of Dr Shroff’s Charity Eye Hospital by donating for :

Cataract Surgeries

  • Rs. 1200 for one surgery
  • Rs 2400 for two surgeries
  • Rs 6000 for five surgeries
  • Rs . . . . . . . . . . . . . . . . for . . . . . . . . surgeries

Cataract Surgeries for Children (more than 6 years of age)

  • Rs 2500 for one child
  • Rs 5000 for two children
  • Rs 12,500 for five children
  • Rs . . . . . . . . . . . . . . . . for . . . . . . . . surgeries

Cataract/Squint/Glaucoma Surgery for Children (less than 6 years of age)

  • Rs 5000 for one child
  • Rs 10,000 for two children
  • Rs 60,000 for five children
  • Rs . . . . . . . . . . . . . . . . for . . . . . . . . children

Rehabilitate Low Vision Persons

  • Rs 7000 for one person
  • Rs 14,000 for two persons
  • Rs 35,000 for five persons
  • Rs . . . . . . . . . . . . . . . . for . . . . . . . . persons.

Retinal Surgery

  • Rs 15,000 for one surgery
  • Rs 30,000 for two surgeries
  • Rs 75,000 for five surgeries
  • Rs . . . . . . . . . . . . . . . . for . . . . . . . . surgeries

One time Donation for Corpus Fund

  • Rs 25,000
  • Rs . . . . . . . . . . . . . . . .

I would like to donate to Dr. Shroff’s Charity Eye Hospital by:

  • Cheque
  • Demand Draft

(Please fill in block letters)
Issuing bank name :
Cheque / Demand Draft No :
Date (DD / MM / YY ): / /


Cheque / Demand Draft to be made in favour of : Dr Shroff’s Charity Eye Hospital

Personal Details :

Name :
Age :
Gender (M / F)
Occupation :
Address :
.
Phone : (R)
             (O)
        (Mob.)
Email :

For people residing in India : Please fill this form and post it with your Cheque/Demand draft information and send it to :
Head, Donor Relations Department,
Dr Shroff’s Charity Eye Hospital,
5027, Kedarnath Road,
Daryaganj, New Delhi-110002.
Email : donate4sight@sceh.net

For people residing in countries other than India :
Cheque to be made in favour of :
Dr Shroff’s Charity Eye Hospital, A/C No. 0117000100363318,
Payable at Punjab National Bank; Swift Code NO: PUNBINBBDOB
Or
For donors in the USA:
Ms. Geeta Gujral
Trustee, Adosh Memorial Charitable Trust
25172, Cypress Street,
Corona, CA 92883, USA
All cheques should be made out to ‘ Adosh Memorial Charitable Trust’, and only on the memo you should write: ‘Charitable contribution for eye care.’ Your contribution to the trust is tax deductible.

For further assistance please write, email or call Donor Relations Department, SCEH.
Visit us at www.sceh.net