standing order form by fB7N0g

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									                                                 STANDING ORDER FORM
If you would like to make a regular donation to nia, please print this form and either post or fax it to us. You can complete
    it on-screen and then print it out and sign it, or print out the blank form and then complete it, whichever you prefer.

               Forename

                Surname

               Address(1)

               Address(2)

               Postcode

               Telephone

                 Email

                              INSTRUCTION TO YOUR BANK/BUILDING SOCIETY
          To the Manager
     Bank/Building Society Name

               Address(1)

               Address(2)

               Postcode

               Sort Code

     Name(s) of account holder(s)

         Your account number


    Please pay nia the sum of £            per       month         quarter       year (please select as appropriate) until further notice.

           Starting on (date)

             Your signature                 ___________________________________ Date _________
nia’s bank details are: The Co-operative Bank, 1 Islington High Street, London, N1 9TR. Account No: 65144749; Sort Code: 08-90-33

                       Thank you for your support. It really does make a difference
                                  If you are a UK tax payer, we can claim tax relief on all your gifts, large or small. This means that if

    giftaid                       you are currently a basic rate tax payer, nia can reclaim 25p for every pound you give. To make
                                  your donation – and our work – go even further, please complete the giftaid declaration below.


□       I am a UK tax payer and pay an amount of Income Tax and/or Capital Gains Tax at least equal to the tax that can
        be reclaimed on my donation.
□       I do not pay tax and this statement does not apply to me.
□       I would prefer not to make a giftaid declaration

								
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