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.)
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| No. | Description of Item | Qty | Approx. Value |
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| 1 | | | |
| 2 | | | |
| 3 | | | |
| 4 | | | |
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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: ____/____/____