TO, DATE:

The General Manager

IG MINT HYDERABAD, IDA Phase II, Cherlapally, Hyderabad-500040

Re.1(FSS) Rs 2 (FSS)Rs 5(NI-

Brass)

Rs 10(Bi-

Metallic)

1100 Years of Civil Aviation of India-2011 A set of Two coins (Rs.100 QA& Rs.5-Ni-Br)

3200/- -- -- -- --

2100 Years of Indian Council of Medical Research(ICMR)-2011 A set

of Two coins (Rs.100-QA& Rs.5-Ni-Br)3200/- -- -- -- --

3C.Subramaniam Birth Centenary - 2010 A set of Two coins (Rs.100

QA& Rs.5-Ni-Br)3200/- -- -- -- --

4Platinum Jubilee of Reserve Bank of India 1935-2010 A set of Two

coins (Rs.75QA & Rs.10-Bi-metallic)3300/- -- -- -- --

5 Platinum Jubilee of Reserve Bank of India 1935-2010 (Rs.1) -- 200/- -- -- --

6 Platinum Jubilee of Reserve Bank of India 1935-2010 (Rs.2) -- -- 250/- --

7 100 Years Of Civil Aviation Of India-2011(Rs.5) -- -- -- 300/- --

8100 Years Of Indian Council Of Medical Research(ICMR)-

2011(Rs.5)-- -- -- 300/- --

9 Platinum Jubilee of Reserve Bank of India 1935-2010 (Rs.5) -- -- -- 300/- --

10150 years of Comptroller & Auditor General of India -2010(Rs.5)

-- -- -- 300/- --

11 Platinum Jubilee of Reserve Bank of India 1935-2010 (Rs.10) -- -- -- -- 350/-

TOTAL AMOUNT (For both single & set of coins)

Above amount is sent herewith by D.D for Rs. --------------------/- drawn in favour of “INDIA GOVERNMENT MINT(A UNIT OF SPMCIL)

Payable at Hyderabad vide D.D. No.---------------dated-------------------- drawn on ----------------------------(name of the bank and branch)

The DD may be sent by Registered Post/Ack. Due only. The Envelop must be super scribed as “Application For Commemorative Coins”.

Name and Postal Address :(In Capital letters)

Name , Street Postal Address: H.No : City

DIST . State : Pin code : Phone No:…………………......

Mobile No. +

Email id :

Note : One DD can be taken for total booking along with the order form,Last day of booking is 27.03.2013

Applicant Signature

ORDER FORM

Name of the Commomerative coin

No of coin

Sets

required

Please book my order for commemorative coins as per the following information:

Sno

Cost of Each

Commomerative

Coin Set

(Rs.)

Denomination and cost of each Coin

A set of Two coins (UNC)

Single Coins(UNC)

Total Amount

of ordered

coin

sets/Coins