Child Sponsor

I/We request Tamil Rehabilitation Fund, User ID - 187024, to arrange for funds to be debited from my/our nominated account at the financial institution shown below according to the schedule specified below.

Name ________________________________________________

Address ________________________________________________

________________________________________________

_____________________________Postcode____________

Phone ______________________

Name and Branch of
Financial Institution __________________________________

__________________________________

BSB No. ___________________

Account Number ___________________

Commencing on ___________________
please debit $ ______________________ from the above account on the
15th of each month

Signature(s) _________________________________________________

_________________________________________________

Date ________________

Please Post the Original form to "Tamil Rehabilitation fund", PO Box 215, Enfield NSW 2136