Standing Order

STANDING ORDER FORM
Please fill out this form with your bank & personal details & send it to us so we can send it to your bank.
To the Manager of: Bank plc
Address of bank:
Account No: Sort Code:
Please pay on the: day of 20 and on
each succeeding month/quarter/year* (delete where not applicable) until further notice to:
Mopane Foundation international, 10-12 Pinstone St, Sheffield S1 2HN
Sort code: 20-12-21 Account no: 13684474 in the sum of £
In words:
I confirm that I wish Mopane Foundation International to treat all donations that I have made since Jan 18th 2010, together with all other donations I may make from the date of this declaration until I notify you otherwise, as GIFT AID DONATIONS. I further confirm that I pay sufficient income or capital gains tax to cover the tax reclaimable by the charity in respect of these donations.
Name:_________________________________________________
Address:_______________________________________________
Phone:_________________________________________________
Email:__________________________________________________
Signed:________________________________________________
Date:__________________________________________________
Please scan and email to: nomsa.neke@mopanefoundation.org
Or post to: Mopane Foundation international, 18 Holgate Avenue, Sheffield,
S5 9LL.
Thank you! From Mopane Foundation International