Leagrave Hall Masjid
A project of Bury Park Educational Institute (BPEI)
Registered Charity No. 1118199
Standing Order Mandate
Please complete all sections in BLOCK CAPITALS
1Donor Details
First Name
Last Name
Email (optional)
Phone (optional)
2Payment Details
Amount (£)
Frequency
Reference to use
LHMDONOR-SURNAME
(Replace SURNAME with your surname)
Start Date
3Beneficiary Bank Details
4Gift Aid Declaration (optional)
I confirm I am a UK taxpayer and want Leagrave Hall Masjid to reclaim tax on all qualifying donations I make. I understand that if I pay less Income Tax and/or Capital Gains Tax than the amount of Gift Aid claimed on all my donations in that tax year, it is my responsibility to pay any difference.
Full Name
Postcode
Home Address
Signature
Date
⚠️ Important
Please complete this form and set up the standing order in your banking app or at your bank branch using the bank details above.
Donor Signature
Date