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O R D E R F O R M

For Offline (Manual) booking

(Booking Period 01-04-2013 to 31-05-2013)

To

The General Manager,

India Government Mint,

Alipore, Kolkata 700053.

Sir,

Please book my order for

Sl. No.Name of Coin SetDenominations of Coin SetsPrice Per Set

Proof Coin

SetUncirculated Coin Set

1.SWAMI VIVEKANANDA-150 Birth Anniversary(1863-1902)2 Coins Set of

150/- & 5/-4,4143,955/-

260 YEARS OF INDIA GOVT. MINT, KOLKATA (1952-2012)2 Coins Set of

60/- & 5/- 3,408/-2,950/-

3.60 YEARS OF INDIA GOVT. MINT, KOLKATA (1952-2012)1 Coin Set

(60/- ) 2,944/--------

4.SANT TUKARAM4 Coin Set

(Rs.100,Rs.50,Rs.10,Rs.2)10,000 9,534`

5,DR. SHYAMA PRASAD MOOKERJEE-CENTENARY4 Coin Set

(Rs.100,Rs.50,Rs.10,Rs.2)11,00410,526

6.LAL BAHADUR SHASTRI-BIRTH CENTENARY(1904-2004)2 Coin Set-(Rs.100& Rs.5)8,1017,667

NAME OF COIN SET

NO. OF SETS ORDEREDTOTAL PRICE

PROOF SETSUNC SETS

Name (full in capital) ..

Postal address (full in capital): House No.Street.

CityState: ..Pin Code: ..

Phone No .. Mobile No ..

Email ID: ..

D.D. NoDate..Drawn on..............................

Bank & Branch for Rs

Place:

Date:

Signature

NOTE:

1. Any application received after closure of the booking date will not be entertained.2. Forms with incomplete ADDRESS and without PIN CODE will not be entertained.3. For security reasons, all the coins will be delivered through Insured Parcel. No hand delivery.4. Demand draft must be drawn in favour of INDIA GOVERNMENT MINT, KOLKATA- A UNIT OF SPMCIL payable at Kolkata (Bankers cheque is applicable only for Kolkata subscribers).5. Separate Forms with Separate DD to be submitted for each type of Coin Set. Applicants name and name of Coin Set booked etc. must be written on reverse of the DD.6. In case of any hike in statutory levies e.g. Central Excise, Central Sales Tax/VAT etc. Costing will be revised and the subscribers have to bear such increase in price.7. State Levy i.e. Octroi, way bill etc. if applicable should be borne by consignee/subscriber at the time of receiving material8. For enquiry please e.mail on calmint@spmcil.com mentioning subject as COIN BOOKING/ Phone no.033-24010132. (between 3 pm to 4 pm) .

9. No query will be entertained after one year of closure of booking. ()

( 01-04-2013 31-05-2013 )

,

,, 700053.,

1. 150 (1863-1903)2 - (`150 & `5 ) 4414

`3955

2. , 60 (1952-2012)

2 (` 60 & `5 ) `3408 `2950

3.

, 60 (1952-2012)

1 ( 60 ) 2944

..........................

4. 4 ( 100, 50, 10, 2 ) 10000 9534

5.

4 ( 100, 50, 10, 2 ) 11004 10526

6

(1904-2004)2 ( 100, 5 ) 8101 7667

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8) - calmint@spmcil.com / : 033- 24010132 ( 3 4 ) 9)