Sri Lankan Psychiatric Association (UK)

Standing Order Form

Your Name………………………………………………………………………………..

Address…………………………………………………………………………………...

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Contact Telephone No……………………………………………………………………

Bank Details

To the Manager:

Name of your Bank….………………………………………..…………………………..

Address of your Bank.………………………………………..…………………………..

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            …………………………………………Post Code………………………………

Bank Sort Code __ __ - __ __ - __ __

Account Number __ __ __ __ __ __ __ __ __ __

Please debit the sum of £ ……… annually to the following Account until further notice

Name of Account:        Sri Lankan Psychiatrists’ Association (UK)

Name of Bank: HSBC plc

Bank Sort Code:          40-10-02

Account Number:         82421437

First Payment Date:      __ __ / __ __ / __ __

Your signature: …………………………………………  Date: …………………………