STANDING ORDER MANDATE

Please print out this form, fill it in, and send it to your bank.

To: ………………………………………………………………………… (Your Bank)

Address: …………………………………………………………………

…………………………………………………………………………………

Please pay: The Co-operative Bank, sort code 08-92-99, for the credit of Swansea

            Bay Asylum Seekers Support Group, account number 65063888 00,

the sum of (amount in figures:) £…………………

(amount in words:) …………………………………………………………………………………

commencing: *Now / *Date of first payment: …………………………………………

and thereafter every *Month / *Other frequency: …………………………………

until *Further notice from me/us in writing / *This date: …………………………

quoting the reference "SBASSG", and debit my/our account accordingly.

Account to be debited:

Name ………………………………………………………………………………

Sort code: …..… - …..… - …..…

Account number:

Signature(s): ……………………………………………………………………… Date: ………………………

           * Delete as appropriate

THANK YOU !!