STANDING ORDER MANDATE
My Contact Details
Name
Address and postcode
Telephone Number
E-mail address
My donation
Please pay the sum of
(in numbers and words):
Commencing on the………. day of the month of…………………. in the year…….
and thereafter every month/quarter/year until further notice and debit my account
accordingly :My Bank Details
My Bank name:
My Bank address:
Account to be debitedName:
Account number:
Sort code:
Please pay:
For the credit of:
Account number:
Sort code:
Gift Aid Declaration
Lloyds Banking Group
Teviot House
41 South Gyle Crescent
Edinburgh, EH12 9DR
The Jamie Devaney Memorial Fund
10917168
77-51-04
Please treat as Gift Aid all qualifying gifts of money. This includes this and all future donations.
 Yes  No
I confirm I have paid or will pay an amount of Income Tax and/or Capital Gains Tax for each
tax year (6 April to 5 April) that is at least equal to the amount of tax that all the charities or
Community Amateur Sports Clubs (CASCs) that I donate to will reclaim on my gifts for that tax
year. I understand that other taxes such as VAT and Council Tax do not qualify. I understand
that The Jamie Devaney Memorial Fund will reclaim 25p of tax on every £1 that I give.
Signature: ____________________________________
Date: ______________________
Please send this form to:
The Treasurer,
The Jamie Devaney Memorial Fund,
5 Mentmore Gardens,
Appleton, Warrington, WA3HF
For more information
web: www.jamiesfund.org.uk
email: [email protected]
Registered Charity Number 1151236