TO:

Name of Bank
Branch Address
Branch Code

Dear Sir,

Please debit my/our current account with the following amount together with all relative charges for payment to:

Beneficiary	HABIBIYAH SOOFIE MASJID
	PO Box 36210, Glosderry 7702
Bank Account Number	8000717138
Bank	First National Bank
Branch	Mowbray
Branch Number	200309
The sum of
Repeat in words
First payment date
thereafter monthly on the

 

This authority is to remain in force until cancelled by me/us in writing.

 

I/we confirm that I/we shall have no claim against the Bank in respect of any consequences of any failure on their

part to make payment on due date.

 

Yours faithfully,

 

                       ..............................................................                                  ....................................

                                       Signature                                                                              Date

 

FROM:

          THIS SECTION TO BE COMPLETED IN BLOCK LETTERS

                                          HOME