SELF-DECLARATION & AUTHORITY TO REPRESENT INVESTOR

Victims’ Rights Protection Trust — Prepare, preview & send declaration (up to 30th Sep 2025)

To, (Trust Details are prefilled below — you may change if needed)

Trust Registration No. (prefilled)

Addressed To (prefilled)

Date

(This declaration pertains to matters and calculations up to)

Declarant / Investor Details

Name

Father / Husband's Name

Age (years)

Profession / Occupation

As per Aadhaar - Permanent Address

City / State / PIN

Mobile / WhatsApp No.

E-Mail

Recipient / Authorized Representative Details (prefilled)

Organization

Convenor

Office Address

Send Declaration File To (email)

Fields background is yellow and border is red as requested. Preview shows letter exactly as will be sent. "Confirm & Send" will try to POST the generated Word (.doc) file to FormSubmit (serverless email service) and send it to the specified email. If automatic sending is blocked by the browser/CORS, you'll get a downloadable Word file to attach manually.