Standing Order Mandate for Sanaton Association

48 Patriot Square, London E2 9AN , www.sanaton.org.uk. Mobile: 0776 559 8485

To The Manager

……………………………………………………………..Bank / Building Society

…………………………………….Branch, Address……………………………….

………………………………………………………………………………………….

1) Account to be debited: (Donor’s account details)

Sort Code: ………………/………………./……………….

Account Number:…………………………………………..

Account Name:………………………………………………

2) Beneficiary Details:

Name: SANATON ASSOCIATION, Registered Charity : 1075313

Sort Code: 20-32-00 Account Number: 80502618

Bank: Barclays Bank Plc,

The Moorgate Group of Branches, 128 Moorgate, London EC2M 6SX

3) Payment Instructions:

I/We would like to make a continuous weekly/ monthly/ annual payment of

£…………………(in words………………………………………………………….)

on every ……………day of the month from my account as above. I authorise

Sanaton Association to claim Gift Aid as I am a basic / higher rate taxpayer.

Signature: Date:

Full Name ……………………………………………………………………………

Address & Telephone:………………………………………………………………