New Standing Order Authority

Please complete in BLOCK CAPITALS and tick the relevant boxes

TO............................BANK

1 PLEASE PAY:-

For Bank Use Only
The James Hopkins Trust Beneficiary/Originator Details
Bank & Branch Lloyds, Lydney
Account 0068742 Computer records checked for matching S/O or D/D ?
Sort Code 30-95-29
2 PAYMENT DETAILS:-
Amount

    £  

Is payment due Today or Tomorrow?

If Yes, advise Regular Payments Staff immediately by fax or telephone to take action
Amount in Words  
When Paid(monthly/yearly)  
Date of FIRST payment                   /            /
Date of Usual payment FIRST of month
Date of Last payment                   /            /

           OR
Please continue Payments until Further Notice YES

   

3 CUSTOMER DETAILS:-
Account in name(s) of

  

 

Bank

  

Branch Address

  

Account Number

  

Sort Code                 --        --
Does this Authority replace an Existing Standing Order ?

If Yes please give Details

 YES

   

 

NO

   

4 SPECIAL INSTRUCTIONS:-
(Include any additional information applicable to this instruction)

 

Special instructions clarified with customer ?
5 CUSTOMER (S) SIGNATURE

** Update ISS records where appropriate

(expert codes ADD/UOD)

Please debit my/our account accordingly

( signed )

   
Telephone Number

Home / Work / Other

Date

             /           /

PLEASE ADD YOUR NAME AND ADDRESS TO THE REVERSE OF THIS FORM

Note ! The Bank will not undertake to:

i) make any reference to Value Added Tax or other indeterminate elements
ii) advise payers address to beneficiary
iii) advise beneficiary of inability to pay
iv) request beneficiary's banker to advise beneficiary of receipt