O R D E R - F O R M

To
The General Manager,
India Government Mint,
Alipore Kolkata - 700 053.
---------------------------------		  
FOR OFFICE USE ONLY
REGISTER NO.
8291(CC)/ONGC  

PROOF

  

UNC

   
Sir,
Please book my order for  "GOLDEN JUBILEE CELEBRATION OF ONGC" (1956 - 2006) Coin sets as under :

 
  Proof Coin Sets Consisting of 2 Coins
Rs.50/- + Rs.5/-		 Uncirculated Coin Sets
Consisting of 2 Coins
Rs.50/- + Rs.5/-
Rate per set Rs.920/- + Tax Rs.502/- + Tax
No. of set (s)    
 
 

RATE SCHEDULE [ INCLUDING TAX & POSTAGE ]
NO OF
SET(S)		 PROOF SETS UNCIRCULATED SETS
DELIVERY BY POST DELIVERY BY POST

1

 1185 715

2

 2300 1360

3

 3415 2005

4

 4530 2650

5

 5645 3295

Total Cost of Set

 = Rs. ________________

Postage

 = Rs. ________________

Total Amount

 = Rs. ________________ 
Above   amount   is   sent   herewith   by  Demand   Draft/ Banker's  Cheque   drawn  in   favour of 
"INDIA GOVERNMENT MINT, KOLKATA (A UNIT OF SPMCIL)" by (D.D No............... Dated.................

Drawn on............................................... [Name of Bank & Branch] for Rs.....................................) 
Name & postal address including Pincode (IN BLOCK LETTERS)
.....................................................................................................................................
.....................................................................................................................................
............................................................................ Telephone No  ....................................


Place :                                                                                                                
Date :                                                                                Signature

Note :

This order form duly filled in and signed has to be sent along with demand draft to INDIA GOVERNMENT MINT, ALIPORE, KOLKATA- 700053 and not to any other address.