Thank you for making this regular gift.
Please complete the details below, items marked with * are mandatory


By proceeding beyond this point you are confirming that you are the account holder and the only person required to authorise Direct Debits from this account.

If you are not or more than one person is required to authorise Direct Debits from this account please do not continue with this web page but instead click here to download a paper mandate for completion.

Your Details

Your email address will let us send you a receipt without incurring further costs.
*Email Address:
*First name:
Must be where the payment account is registered.
*House No/Name :
Address Line 2 :
Address Line 3 :
Address Line 4 :
Post Code :  

Your Direct Debit

Service User Number :

Image - Direct Debit

Please enter your donation amount :
*Amount :
*Account Name :
*Account Number :
*Sort Code :
*Start Date : why only these dates
* Payment Frequency :
The payment will appear on your statement as TLMS
Image - Direct Debit

This Guarantee is offered by all banks and building societies that accept instructions to pay Direct Debits.

If there are any changes to the amount, date or frequency of your Direct Debit The Leprosy Mission Scotland will notify you 10 working days in advance of your account being debited or as otherwise agreed. If you request The Leprosy Mission Scotland to collect a payment, confirmation of the amount and date will be given to you at the time of the request. 

If an error is made in the payment of your Direct Debit by The Leprosy Mission Scotland or your bank or building society you are entitled to a full and immediate refund of the amount paid from your bank or building society. 

If you receive a refund you are not entitled to, you must pay it back when The Leprosy Mission Scotland asks you to.

You can cancel a Direct Debit at any time by simply contacting your bank or building society. Written confirmation may be required. Please also notify us.

The Gift Aid Scheme

Boost your donation by 25p of Gift Aid for every £1 you donate

Gift Aid is reclaimed by Leprosy Mission Scotland from the tax you pay for the current tax year. Your address is needed to identify you as a current UK taxpayer. If you pay Income Tax at the higher or additional rate and want to receive the additional tax relief due to you, you must include all your Gift Aid donations on your Self-Assessment tax return or ask HM Revenue and Customs to adjust your tax code.

Please notify Leprosy Mission Scotland if you want to:
- cancel this declaration.
- change your name or home address
- no longer pay sufficient tax on your income and/or capital gains

In order to Gift Aid your donation you must tick the box below:

Other Information

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Any queries about this site or your Direct Debit please contact:
The Leprosy Mission Scotland
Suite 2 Earlsgate Lodge
Livilands Lane

Tel: 01786 449 266

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