Hamlin Fistula UK

Exclusively supporting the Addis Ababa Fistula Hospital in Ethiopia
    Home > Ways of Giving > Bankers Order Form
    Please complete this form on-line and print it.  After signing it, send it to:  Hamlin Fistula UK, 4 Parade Buildings, Nimmings Road, Halesowen B62 9JJ

 

Bankers Order Form

Please pay to Hamlin Fistula UK the sum of:
£(words)
Annually      (Choose one only)
Monthly		 Please initial here:
until countermanded by me, starting on
(Date)
to Lloyds Bank Plc B63 3BQ
Branch Code:  30-93-75  Account Number:  00204184   
Signed
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 Bankers Order payable to this Charity

THIS FORM SHOULD NOT BE SENT DIRECT TO YOUR BANKERS

Gift Aid Declaration 

I confirm that

I wish this and all future contributions donated to Hamlin Fistula UK to be treated as Gift Aid donations under the new Gift Aid Scheme. I am a UK taxpayer and pay an amount of Income Tax and/or Capital Gains Tax at least equal to the tax that can be reclaimed on my donation.  I will advise you if there are any changes to this status.
I am not a UK taxpayer.

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This site was last updated 20/10/10