IN-KIND DONATION (OBJECTS) FORM Form Code: HSW-F27

 HSWAGATA BUDDHA TOOTH RELICS PRESERVATION MUSEUM

IN-KIND DONATION (OBJECTS) FORM

Form Code: HSW-F27

Date: ____ / ____ / ______

Form Number: ____________________________

1. DONOR DETAILS

   1.1 Donor Name: ________________________________

   1.2 Address:

       ___________________________________________

       ___________________________________________

   1.3 Phone / Email:

       ___________________________________________

2. DONATED ITEMS

   (Use table; add rows as needed.)

   -------------------------------------------------------------------------

   | No. | Description of Item                      | Qty | Approx. Value |

   -------------------------------------------------------------------------

   |  1  |                                          |     |              |

   |  2  |                                          |     |              |

   |  3  |                                          |     |              |

   |  4  |                                          |     |              |

   -------------------------------------------------------------------------

3. CONDITION

   Overall condition:

   [ ] New   [ ] Good   [ ] Fair   [ ] Poor

   Notes on condition (if needed):

   ___________________________________________

   ___________________________________________

4. INTENDED USE

   [ ] Office / equipment

   [ ] Education / outreach

   [ ] Exhibition (non-relic)

   [ ] Other: __________________________________

5. SIGNATURES

   Donor:

   Name: ______________________________________

   Signature: __________________ Date: ____/____/____

   Receiving Officer:

   Name: ______________________________________

   Department: ________________________________

   Signature: __________________ Date: ____/____/____