Deposit Form

 

Please print out the form below and return completed and signed to;                  

EKPCA, 11, Boorman Way, Estuary View Business Park, Whitstable, Kent, CT5 3SE

Telephone: 01227 272944.    Email:      

 

1.     I enclose £               :             which I wish to deposit in accordance with the currently published Rules of the Association

 

         on behalf of ……………………………………………………………….………………………………………

 

           …………………..…………………………………………………    Account No. ……….…………..................................................

 

         and instruct you to apply my/our donation as follows: 

 

2014 Festival:- see new 2014 Dual Mandate Form   Freemasons' Grand Charity   MSF   RMBI           
  RMTGB    PGM’s Charity To Be Advised  Other (Supply details below):

                                  

 (Please tick your choice.  If more than one is indicated donations will be divided equally) 

 

2.    Charity………………………………………………………………………………………………………………………….

 

   Address…………………………………………………………………………………………………………………………

 

 

3.     Surname……………………..……...……… First Names………………………………..............………………...

 

Address…………………………………………………………………………………………..…………………

 

.........................................................………………………………..……….…….. Post Code………..…………..

 

Tel. No. …..……………………………….  Email......................................................................................................................................

 

Credit to Lodge Name & No. ……………………………………………………………………………….………………

 

Account No. ..........................................................................................................................................................................

 

 

4.          Signed ………………………..……..….....…….. Signed ….………….………………...………….. Date ……………...

 

Data Protection Act: If you do not agree to the details of your account with the Association being made available to your Lodge Charity Steward, please tick:

Office Use:

  

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 See notes below:

 

1.  Only complete the “on behalf of….”  portion of Section 1 if the donation is from a Premium 'A' Member or a Junior under the age of 16. Enter the Junior's date of birth in 'Day, Month, Year' format.

2.  Tick one or more boxes in Section 2.  When more than one box is ticked the donation will be divided equally between the charities indicated. If the choice is to a charity other than the selection provided, enter the full name and address of the charity in the section provided below.  The choice must be to a recognised charity or charitable cause; only Premium 'A' Members (e.g. Lodges) can donate directly to individuals.  Instructions given are irrevocable.

3.  Complete Section 3 in every case.  Use 'Day, Month, Year' format for the date of birth which is essential for positive identification.  If you are (a) the nominated representative of a Premium ‘A’ Member or (b) the sponsor of a 'Junior' under the age of 16, you should complete this section and the “on behalf of…” in Section 1.  If the donation is to be credited to a Lodge, Chapter or Order total for an appeal or Festival, add the number of the Lodge or Chapter or the name of the Order at “Credit to……”..

4.  Single signatures are required from Ordinary Members who sign on their own behalf or on behalf of Junior Members under the age of 16.  Two signatures are required from Premium ‘A’ Members - the nominated representative together with another Lodge or Club official.  Please indicate the office held by each signatory.

 

 

East Kent Provincial Charities Association is a Registered Charity No. 1023859