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Hamlin Fistula UK

Exclusively supporting the Addis Ababa Fistula Hospital
and the Hamlin College of Midwives

Wholehearted commitment to women with childbirth injuries, with God's love and compassion
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Bankers Order Form
Please complete this form on-line and print it (using your browser's File/Print command).  After signing it, send it to:  Hamlin Fistula UK, 4 Parade Buildings, Nimmings Road, Halesowen B62 9JJ
Please pay to Hamlin Fistula UK the sum of:
£   (words)
Annually            (Choose one only)
Monthly
 
until countermanded by me, starting on:   (Date)
to TSB plc, B63 3BQ
Sort Code: 30-93-75   Account Number:  00204184
Signed: (First Signature)
Your Bank Name and Address : Your Name and Address :
Name of Bank Account to be Debited:
Bank Sort Code:   - -   Your Account Number:

Please cancel any existing Direct Debit Mandate payable to this Charity.

If you wish your contribution to be a Gift Aid donation, please click here(This will open up a new window with a form you will need to download and complete.) 
Thank you for doing this as it greatly increases your contribution to our work.

Signature: (Second Signature)
Date

THIS FORM SHOULD NOT BE SENT DIRECT TO YOUR BANKERS