ElectricAid

ESB Staff Fund                                                                              

27 Lower Fitzwilliam Street,Dublin2

Telephone 01 7027732

ElectricAid once-off donation form

Name  ______________________________________________________

Staff No  ______________________

Work location _________________________________________________

Signature ___________________________________________________

Please deduct once-off from my salary/pension and pay to ElectricAid:

€5:                               _________________

€10:                            _________________

€20:                            _________________

€50:                            _________________

Other Amount:           _________________

The amount deducted to be paid  to ElectricAid – payroll code 5202. I understand that my contributions may be used for all ElectricAid projects – home and abroad.

Please print this page and complete it. Send the completed form by post to the address above.