STANDING ORDER FORM To Bank Sort Code Account No Account Name Branch Address Beneficiary Name Mityana Charity Beneficiary Sort Code 40-47-09 Beneficiary Account Number 41515667 IBAN GB48HBUK40470941515667 BIC HBUKGB4113F Reference (optional) Amount Date of first payment Amount of subsequent payments (if different from first payment) Date of final payment or Until Further Notice (UFN) Due date and frequency of payments Signature Date Please send the above completed form to your bank and a copy to us. The form does not "go anywhere" on-line. Please fill in, print, sign and post the form to your bank and send a copy to: Treasurer, Mityana Charity 57 Trevelyan, Bracknell, RG12 8YD