Postage will be paid by

addressee.For posting in

Singapore only.

BUSINESS REPLY SERVICE PERMIT NO. 07526

Attn: Corporate Service Dept (CSD)LEMBAGA PENTADBIR MASJID AL-ISTIQAMAH

2 Serangoon North Ave 2Singapore 555876

Dengan Nama Allah Yang Maha Pengasih Dan Maha Penyayang,

Rakan Istiqamah adalah usaha murni untuk mengajak para penderma menjadi teman akrab Masjid Al-Istiqamah.

Amalan tambahan serta saham akhirat anda yang tidak diketahui orang. Sumbangkan setiap bulan menerusi Giro.

Jadilah Rakan Istiqamah demi menjaga dana peningkatan Masjid kita. Semoga Allah memberkatiusaha kecil kita ini, Amiin.

Hj Juraiman Bin RahimPengerusi Eksekutif, Masjid Al-Istiqamah

#membentukperibadimuslim

Rakan IstiqamahMenjadikan Masjid Al-Istiqamah pusat kecemerlangan

pembelajaran Islam dan pembangunan sosial

Rasulullah s.a.w. “Amalan yang disukai Allah ialah yang berterusan walaupun sedikit." [HR Muslim]

a)

b)

c)

Application Form for InterBank Giro

-

Bank Name:

Branch:

Bank Account Number:

My

My Name:

NRIC/FIN/UEN

Tel / Hp:

I/We hereby instruct you to process the BO’s instructions to

debit my/our account. You are entitled to reject the BO’s debit instruction if my/our

account does not have sufficient funds and charge me/us a fee for this. You may also at your discretion allow the debit even if this results in an overdraft on the account and impose charges accordingly.

This authorisation will remain in force until termination by your written notice sent to my/our address last known to you or upon receipt of my/our written revocation through the BO.

For Official Use Only To: Lembaga Pentadbir Masjid Al-Istiqamah 2 Serangoon North Ave 2, S’pore 555876

This application is hereby REJECTED (please tick) for the following reason(s):

Signature/Thumbprint* differs from Bank’s record Signature/Thumbprint* incomplete/unclear* Account operated by signature/thumbprint* Wrong account number Amendments not countersigned by customer Others:

Name of Approving Officer

Authorised Signature

Date

* Please delete where inapplicable.

Part 3: For Bank’s Completion Part 2: For Billing Organisation’s Completion

Name of Billing Organisation (“BO”):

LEMBAGA PENTADBIR MASJID AL ISTIQAMAH

BO’s Customer Reference No.

Limit of each payment (excludes cents)

Bank Branch BO’s Account No.

7339 581 842143001

Bank Branch Account No. to be debited

Part 1: For Applicant’s Completion

Company Stamp/Thumbprint(s)/Signature(s) as in Bank’s Records:(For thumbprints, please go to the branch with your identification)

Saya Adalah Rakan Istiqamah Berikut ialah butiran peribadi saya :

Derma Peribadi Derma Korporat

*Nama / Korporat:

Alamat:

E-Mel:

.

**Saya mengikrarkan jumlah bulanan seperti berikut

Cara menyumbang:1. Dermaan sekali sahaja kepada Masjid Al-Istiqamah sebanyak $

-AlSaya lampirkan cek atas nama “Lembaga Pentadbir Masjid Istiqamah”. Catatkan “Rakan Istiqamah” di sebalik cek.

2. (Sila tandakan) :

Tel / Hp:

3. Tarikh pemotongan daripada akaun saya (pilih satu) : 3hb 16hb

(Sila isikan borang Giro Part 1)

*Anda boleh sertakan atas nama arwah sebagai amal jariah yang berterusan bagi yang telah tiada disisi.**Bagi penderma yang ingin tingkatkan jumlah ikrar, sila isikan borang ini sekali lagi dengan jumlah yang baharu.(Jumlah potongan akan bermula daripada akaun pengikrar setelah mendapat kelulusan dari pihak bank)

$100 $50 $20 $10 $5 $ _____________ (jumlah lain)

Postal Code:

Date: