Artist Relief Fund Request Form
Name of the Artist
*
First Name
Last Name
City
*
Email
example@example.com
Phone Number
*
Please enter a valid phone number.
Artform
*
Experience
How can we help?
*
Please Select
Grocery Kit (worth Approx. Rs. 3500 per family)
Medicines (worth Approx. Rs. 3500 per family)
Oxygen Concentrator (for emergency need)
Medical Consultation
Other
Reference by
*
Bank Details or GPay Details
*
Grocery Kit Status
Submit
Should be Empty: