Standing Order Mandate
Please complete this form in BLOCK
CAPITALS
(Full Address)
| 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. |
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
__________________________________
__________________________________ |
|
I / We acknowledge the bank
will not undertake to:
(i) make any reference to
Value Added Tax, or any other indeterminate element
(ii) advise payer’s address
to beneficiary
(iii) advise beneficiary
of inability to pay
(iv) request beneficiary’s
banker to advise beneficiary of receipt
| Customer(s)
Signature(s) ______________________________________ |
| Date ....
/ .... / .... |
|