Donations Form with Gift Aid Declaration

							                                                                                Donations Form with Gift Aid Declaration
DETAILS OF SUPPORTER:

Title …………              Forename(s) ……………………………………… Surname ……………………………………

Home Address …………………………………………………………………………………………………………..

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

Postcode ……………………………. Telephone ……………………………………………………………………

Email address ……………………………………………………………………………………………………………



DETAILS OF DONATION:

Amount: £ …………

How the money was raised:……………………………………………………………………………

Any other individuals or groups involved in raising this money: ………………………………



Signature …………………………………………………….                                                             Date …………………………..

Please tick if you require an acknowledgement:                                  


I am interested in:

Fundraising for CHSW                         Joining my local Friends’ Group                               Volunteering 

I would like to receive:

Newsletters             Email newsletter                  Memory Star               Christmas card leaflet                  Bluebell Walk 

Invitations to future Open Days                     Memory Walks                  Skydives 

I would like to make a regular gift to CHSW, please send me a Direct Debit form 



I want the charity to treat all donations I have made in the past four years and all donations that I make in the
future from the date of this declaration as gift aided donations until I notify you
otherwise.

I understand that I must pay an amount of United Kingdom income tax and/or
capital gains tax at least equal to the tax that the charity reclaims on my donations
in the tax year.


Date …………../…………../……………                                  Signature …………………………………

NOTES

1.   You can cancel this Declaration at any time by notifying the Charity.
2.   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
     must cancel your declaration (see note 1).
3.   If you pay tax at the higher rate you can claim further tax relief in your Self Assessment tax return.
4.   If you are unsure whether your donations qualify for Gift Aid tax relief, ask the Charity. Or ask your local tax office for leaflet IR65.
5.   Please notify the Charity if you change your name or address.

Children’s Hospice South West, Little Bridge House, Fremington, Barnstaple, North Devon, EX31 2PZ