Please complete all information in Block Capitals.
Details of Donor:
Title Forename(s) Surname 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
Signature __________________________________ Date / /
Registered Charity Number: 257853