Standing Order Mandate
Please complete this form in BLOCK CAPITALS
 
 
To   Bank
 
 
Sort Code             
 
 
 
  Branch
(Full Address) 
 
 
A.  Customerís details
 
 
Account name  
 
Account Number                 
 
Tel. No. - Work   Tel. No. - Home  
 

Please set up the following Standing Order and debit my / our account accordingly 
 
 
B.  Person / Organisation you wish to pay
 
 
Name of Person / Organisation: POVERTY AFRICA UK 

Bank & Branch Name: NAT WEST, BOROUGH GREEN, P.O. BOX 177, SEVENOAKS, KENT, TN15 8NX. 

Account Number: 09644903 Sort Code: 51 81 07 

Reference to be quoted: MKOMBOZI CENTRE FOR STREET CHILDREN.

 
 
 
C.  About the payment
 

Amount Details 
 
Amount of first payment (If different) £ ___ Amount of normal payment £ ___
Amount of normal payment in words  

When Paid 
 
Day or dates of payments ____________________

(e.g. Friday, 1st, 30th May)

 Frequency  _________

(e.g. weekly, monthly, yearly)

Commencing _____________________

Now  

Date .... / .... / ..... 

(Delete as appropriate)

Payments until further notice ( Y / N )  
Special instructions 
__________________________________
__________________________________
 
 
D.  Confirmation
 
I / We acknowledge the bank will not undertake to: 

(i) make any reference to Value Added Tax, or any other indeterminate element 

(ii) advise payerís address to beneficiary 

(iii) advise beneficiary of inability to pay 

(iv) request beneficiaryís banker to advise beneficiary of receipt 
 
 
Customer(s) Signature(s)  ______________________________________
Date  .... / .... / ....