Banker's Order Form For Regular Donations

Please print and complete the following form, then send it to the Islamic Shariah Institute, PO Box 6008, Birmingham, B10 0UW, UK.

Name >
Address >
Postcode > Telephone >

Please pay the Islamic Shariah Institute

each Month/Quarter/Yearly Until further notice
Account No. > Sort Code > Start Date >
Signature > Date >
To the Manager > Bank Plc
Address >
> Postcode >
This cancels all existing Bankers Orders to the Islamic Shariah Institute Yes No
For Office Use Only:To Natwest Bank Plc, Sparkhill Branch, Birmingham, England, (60-20-42)
account number 80235654 quoting our reference >