Match Making

The Fees for Match Making is 10 U.S. Dollar or 500 Indian Rupee. To continue please fill in the following form. Pay to my bank account. The bank details will be emailed to you.

( Bengali,English,Hindi & any other language Also Available ).
All Style Also Available.

Male

First Name	:
Middle Name	:
Last Name	:
Date Of Birth	:
Time Of Birth (hh:mm:ss)	:	: :
City Of Birth	:
State of Birth	:
Country of Birth	:
Tele number (Local code)	:
Email	:

Female

First Name	:
Middle Name	:
Last Name	:
Date Of Birth	:
Time Of Birth	:	: :
City Of Birth	:
State of Birth	:
Country of Birth	:
Tele number (Local code)	:
Email	:

Payment Details:

Method	:	Cash Cheque Demand Draft Note: Cheque or Demand Draft should be drawn in favour of "Vivekananda Roy".
Cheque/Draft No	:	(please type N/A for cash)
Cheque/Draft Date	:	(for cash please enter payment date & place)