Details Of Donor:

Title:_______________________________

Forename(s)_________________________________

Family name_________________________________

Address:____________________________________

___________________________________________

___________________________________________

Post Code:______________

Notes:

1. You must pay an amount of income tax and/or capital gains tax at least equal to the tax that the charity reclaims on your donations in the tax year.

2. You can cancel this declaration at any time by notifying the charity.

3. If in the future your circumstances change and you no longer pay tax on your income and capital gains equal to the tax that the charity reclaims, you can cancel your declaration (see note 1).

4. If you pay tax at the higher rate you can claim further tax relief in your Self-Assessment tax return.

5. If you are unsure whether your donations qualify for Gift Aid tax relief, ask the charity. Or ask your local tax office for leaflet IR 65.

6. Please notify the charity if you change your name or address.