STANDING ORDER AUTHORITY
 
To the Manager______________________________________Bank
 
Branch Address__________________________________________
 
________________________________________________________
 
________________________________________________________
 
Branch Sort Code:
 
 
Account Number: ____  ____  ____  ____  ____  ____  ____  ____
 
Name of Account Holder:__________________________________
 
I wish to pay the sum of £10 (Ten Pounds) to the
LloydsTSB Retirement Club, Birmingham (LTSBRCB)
with immediate effect and
Annually on January 1st each year until further notice.
Payments to be made to LTSBRCB at:
 
Lloyds Bank (30-16-84)
776 Hagley Road West
Oldbury
B68 0PJ
 
Account Number: 00811450
 
___________________________________________
(Signature)
 
______________________________
(Date)
 
Please return this form to:
David Parkes, 5 Hollywell Road, Knowle, Solihull, B93 9JY
 
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