STANDING ORDER MANDATE (NEW INSTRUCTION)
(PLEASE COMPLETE THIS FORM IN BLOCK CAPITALS)

                        Bank Details


To ___________________________________________________________________________ Bank

Full Address ___________________________________________________________________

Sort Code

Your Details

Account Name ______________________________________________________________

Account Number

Tel. No. (Work) _____________________________ (Home) _____________________________

Please set up the following standing order and debit my / our account accordingly

Organisation you wish to pay

Name of Organisation: LOTTO28                 Bank / Branch name: THE CO-OPERATIVE BANK / BUSINESS DIRECT

Account No. and Type 6 9 1 7 3 8 2 6 X 0 0
Sort Code 0 8 9 2 9 9

Reference to be quoted: LOTTO28

Amount of Regular Payment:
Date of Regular Payments 15th OF EVERY MONTH

Date of First Regular Payment ________________________________________
(Please leave for Lotto28 to complete)

Payments are to be made until further notice

Your Signature (s) _______________________________________________________

Date ____________________________________________

(Please ensure that this mandate is signed in accordance with your account mandate)