Address…………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………………………

…………………………………………………………………………………………… Postcode…………………………………

I want the charity to treat

*The enclosed donation of £…………………………………………………

*The donation(s) of £……………………………which I made on ……/……/…………

*All donations I make from the date of this declaration until I notify you otherwise as Gift Aid donations

(*Delete as appropriate)

Signed……………………………………………………………………………………Date……/……/…………

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 donation in the tax year (currently 28p for each £1 you give)
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 reclaim further tax relief in your Self Assessment tax return.
5. If you are unsure whether you donations qualify for Gift Aid tax relief, as the charity, or ask your local tax office for leaflet IR65.
6. Please notify the charity if you change your name or address.