By signing this form, you authorise Stichting Tara Bodong (Netherlands) to send recurring collection instructions to your bank to debit your account for a donation to support Stichting Tara Bodong, in accordance with the amount stated below. If you do not agree with the debit, you can arrange for its refund. Please contact your bank within eight weeks from the date on which your account was debited. Ask your bank for conditions.