Standing Order Form

Send to: Janice Hedge, Communications Group, MDG, 26 Emanuel Avenue, Acton, London W3 6JJ

To the Manager

Bank:
…………………………………………………………………
Address:
   …………………………………………………………………
 
   …………………………………………………………………
 
   …………………………………………………………………
Post Code:
   …………………………………………………………………
My account details are as follows:
Account Name: …………………………………………………………………
Account Number: …………………………………………………………………
Branch Sort Code: …………………………………………………………………

Please pay the sum of £ ……………………………… to the Mali Development Group

each month, on the ………………………………..…………………… of each month

commencing on ………………………………..……………………… and until further notice

Recipient Bank details are as follows:
Account Name: Mali Development Group
Bank branch: Lloyds/TSB, The Square, Botley, Oxford
Sort Code: 30-19-83
Account Number: 0215663


Signed: ………………………………………….


Date: ……………………………….…………

Gift Aid declaration
(Please sign this declaration as this will allow us to receive extra money by claiming back the tax you have already paid on the amount you are giving.)

I am / We are a tax payer in the United Kingdom relative to amounts donated and would like the charity to treat all donations I make from the date of this declaration until I notify you otherwise as Gift Aid donations. I am over 18


Signed: ………………………………………….


Date: ……………………………….…………