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Bangla Newsmonthly
Brihaspati
Subscription Form
Please fill in Capital letters, cut and send to Brihaspati, Shriniketan Gr., Fl., Plot -15A,
Station Road, Opp. Hotel Ashray International, Sion (Naka), Mumbai 400022.
Name: ...................................................................................................................................
Address:.................................................................................................................................
....................................................................................................................................................................................
Phone:.....................................Mobile: ................................................................................
E-Mail: ..............................................................................................................................
I have attached herewith an Account Payee (Crossed) Cheque / Draft No...................................
dated........................................of....................................................................................................Bank,
...........................................................................Branch in favour of BRIHASPATI for Rs..................
Rs (In words)...........................................................................................................for....................months'
subscription of Brihaspati to be started from............................................2005 upto December 2005. *
*
Please subscribe only upto December 2005 in this form, not for more period. You may extend
your Subscribing period from January 2006 to December 2006 through the separate form which
will be published in our October, November & December 2005 issues. Please calculate the amount
@ Rs 10.00 per copy. Postage free. Photocopy (Xerox) of this form is acceptable.
Date :.........................................
Signature of Subscriber
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FOR OFFICE USE ONLY
Name of the subscriber : ..................................................................................................-
Starting issue No. & Date : ................................................ Received Rs.........................
Rs......................................................................................................................................
by Cheque / DD No.....................................................................dated.............................
of..............................................................Bank,.................................................................Branch.
Subscriber's Serial No.: .............................................. Subscribed upto December 2005.
Date....................................
Manager, Brihaspati