Your name and address ................................................................................................

....................................................................................................................
SHIVA Charity Child Sponsorship Form (5 per month)
Your Bank/ Building Soc. name and

address .......................................................................................................

             ......................................................................................................
Alliance & Leicester Commercial Bank PLC (Bootle)
For the credit of Schools Helping India Voluntary Association (SHIVA)
Sort Code 72-00-05    Account 32206185

The Sum ............   Amount in Words   ......................................................

Starting on ......./....../...... and on the same day each month until further notice

SIGNED...............................     DATE ......./......../.......  Bank Account Number ...........................

Sort Code  .........................   Account in the name of  ..................................................
Please tick here        if you are a UK taxpayer and would like your donations Gift Aided (adding tax free giving).

SIGNED..........................................     email address (if you have one)..........................................
Post completed form to: Bob Uppington (SHIVA Charity) 19 Daventry Rd., Knowle, BRISTOL BS4

www.shivacharity.com           email bob@shivacharity.com               Regd. charity 1045197
PRINT THIS FORM AND SEND TO SHIVA CHARITY 19 DAVENTRY RD BRISTOL BS41DQ