BANKER'S ORDER FORM

Please forward this order for registration to the Treasurer at La SociŽtŽ Guernesiaise, Candie 

Gardens, St Peter Port, Guernsey GY1 1UG, who will forward it to the Bankers named therein.

To: (name and address of your Bank)  ___________________________________________________________

___________________________________________________________  A/C No. ___________________________

Please pay to NatWest Bank PLC. Guernsey, sorting code 60-09-20, for the credit of La SociŽtŽ 

Guernesiaise, Account No. 67019609, the sum of £ _________ on (date) ____________________ and 

annually for _________ years, and debit my/our account accordingly.

NAME  __________________________________  ADDRESS  ______________________________________

__________________________________________________________________________________________

SIGNATURE  ______________________________________  DATE  ________________________________