The Story of Tír na nÓg - Tír na nÓg Orphanage

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Direct Debit Mandate

By signing this mandate form, you authorise (a) Tír na nÓg Orphanage CLG to send instructions to your bank to debit your account and (B) your bank to debit your account in accordance with the instructions from Tír na nÓg Orphanage CLG. As part of your rights, you are entitled to a refund from your bank under the terms and conditions of your agreement with your bank. A refund must be claimed with 8 weeks starting from the date on which your account was debited. Your rights are explained in a statement that you can obtain from your bank.

Creditor's Name: TÍR NA NÓG (TNN)
Creditor's Identifier: IE71SDD362504
Creditor's Address: 16 THE KERRIES BALLYRICKARD TRALEE CO KERRY V92VW1H

Please complete all fields marked * (PLEASE USE BLOCK CAPITALS)

Debtor Name *

Email *

Debtor Address *
Address Line 1
Address Line 2
City
State / Province / Region
Postal Code
Country

Debtor Address mandatory when collecting from a non EEA SEPA country or territory

Debtor Account Number – IBAN *

Debtor Bank Identifier Code - BIC *

Type of payment *
Recurrent payment
One-off payment

Donation Amount:

Signature *

Date

Phone