Sir,
Having completely read or caused to be read and fully understood the rules governing the conduct of the chit herein printed, a copy of which was signed and delivered to you which is proposed to be started by you from ..........day of ....and assessed to same. I/we send a sum of Rs. Ps. .....(Rupees................Paise.............)by money order / cheque/remittance in cash at................being the payment on a full ticket valued at Rs..................due for the first instalement and request you to allot me/us the ticket. I/We agree to any change in the date of the commencement of the chit. )

Yours Faithfully