Standing Order Form
To the Manager at :
...Bank / Building Society
Bank Address:
.
.
.
Please pay to the account of Prospex at: HSBC, Lion House, 25 Islington High St, Islington, London, N1
9LJ. Sort Code: 40-03-33, Account No: 21328786, the sum of:
£5 per month OR per month, starting on the ..
of
.
.
, 2004
(day) (month)
(please delete/ complete as appropriate)
Account Name:
...............................
Account No:
.
Sort Code: - -
Name: ..
.........................................................................
Address: ..
.
..
Signature(s)
..Date
.../
..../
..
GIFT AID
If you are a UK taxpayer and tick the box below, your gift can be
increased by 28% under the governments Gift Aid scheme
I would like Prospex to reclaim the tax I pay and have paid on all my donations made since 6th April 2000
and any further donations I may make. I pay and have paid income or Capital Gains Tax (in the UK) equal to
the tax that Prospex will reclaim (currently 28p for each £1 I give)
Signature(s):
...Date:
/
./
.
