Standing Order Mandate

 
Please complete this form in BLOCK CAPITALS    
TO ________________________________Bank
Sort Code:
           
     
Branch_________________________________________ _____________ _____________
(Full Address)    
A) Customer      
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 : In-Community Care for Orphans
Bank and Branch Name : NatWest, High Street Branch, Southampton, Hants
Account Number
5
8
6
5
1
6
8
3
Sort Code
5
6
0
0
6
8
Reference to be quoted (if any) :-
C) About the Payment
Amount Details (if the amount of the periodic payments vary they should be incorporated in a schedule overleaf)
Amount of First payment (if different) £ Amount of Normal payment £
Amount of Normal payment in words :  
Amount of Final payment (if different) £  
When Paid (Please note : Payment to an account held at Natwest will normally be received by the beneficiary on the nominated payment date.Payment to an account held at a different bank will be received by the beneficiary 3 working days after your nominated payment date.)
Day or date of Payments
(eg Friday, 1st, 30th May)
 Frequency
(eg weekly ,monthly, yearly)
Commencing
 Now   / Specific Date   __/__/__    (Delete as appropriate)
Total No of Payments: [__]
or Expiry Date __/__/__    or Until further notice [_]

Special Instructions

 

D Confirmation

I/We acknowledge the Bank will not undertake to:

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

 

Bank Use Only

Keyed by _____ (initials)

Date ______________
Customer(s) Signature(s) ________________________________________
 
Date ______________________