KIDNEY WALES FOUNDATION                    Head Office:

                                                                       1-3 Museum Place, Cardiff CF10 3BD

                                                                       Tel: (029) 2034 3940

                                                                        Fax: (029) 2034:4130

 

SEFYDLIAD AREN CYMRU                           Prif Swyddfa

                                                                        1-3 Museum Place, Caerdydd, CF10 3BD

                                                                        Ffon: (029) 2034 3940

                                                                        Cyf: (029) 2034 4130

 

Rhif Elusenol / Charity No: 700396                                                                 Rhif Cof. Cwmni / Company Reg No: 2268003

 

To / At Fanc: .......................................................... Bank       Sort Code………………………………

                                                                                                Cod Didoli’r ……………………………

Postal Address

Cyfeiriad Post:            ..........................................................................................................................

Please pay

 

Taler

Bank

Banc

Branch Title (not address)

Teitl y Gangen (nid y cyfeiriad)

Sorting Code Number

Cod Didoli’r Banc

HSBC

Queen St, Cardiff

40-16-15

For  the credit of

 

i gredyd

Beneficiary’s Name

Enw’r Buddiolwr

Account Number

Rhif y Cyfrif

Quoting Reference / Gan Ddyfynnu’r Cyfeirnod

Kidney Wales Foundation

3

1

7

0

5

8

0

6

 

the sum of

/ y swm o

Ammount / Swm

Ammount in words / Swm mewn geiriau

£

 

commencing

 

dechrau

Date of first payment

Dyddiad y taliad cyntaf

and thereafter every

ac yna bob

Due date and frequency

 

Dyddiad ac amlder

until further notice in writing or

 

oni hysbysir yn ysgrifenedig ymhellach

Date of last payment

 

Dyddiad y taliad olaf

and debit my/our account accordingly

gan ddebydu fy nghyfriflein gyfrif yn unol â hynny

 

 

 

 

PLEASE CANCEL ALL PREVIOUS STANDING ORDER/DIRECT DEBIT MANDATES IN FAVOUR OF / DILEER POB MANDAD ARCHEB SEFYDLOG/DEBYD UNIONGYRCHOL BLAENOROL I

UNDER REFERENCE NO / O DAN GYFEIRNOD RHIF

Account to be debited

Y cyfrif i’w ddebydu

Account Number

Rhif y Cyfrif

 

 

 

 

 

 

 

 

 

 

 

Special instructions / Gorchmynion arbennig

 

Signature(s)                                                                                                    Date

Llofnod(ion)     ...........................................................................................     Dyddiad .........................