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HACKNEY COALITION TO SAVE THE NHS

Standing Order Mandate


Please print clearly
To The Manager:

Your Bank

Bank Address
.Post Code
Sort Code: Account no:

Your Name
Please pay the sum of: .. per month to the account of Keep Hackney NHS
Public, Unity Trust Bank, Nine Brindley Place, Birmingham B1 2HB
Sort Code: 08 60 01 Account number: 20179157
Starting on (insert date) .. and please continue to make this payment until
notified by me in writing.

Signed Date:

Please send your cheque and/or S/O Mandate to:


Hackney KONP c/o 26 Framlingham Close, London E5 9PR

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