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

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

……………………………………………………………………………………

………………………………………………… Post Code ……………………

I want the charity to treat

*the enclosed donation of £ ……………… as a Gift Aid donation

*the donation(s) of £ ………………………which I made on ……/……/…… as (a) Gift Aid donation (s)

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

*all donations I have made for the six years prior to this year, (but no earlier than 6/4/2002) and all donations I make from the date of this declaration until I notify you otherwise, as Gift Aid donations.

*delete as appropriate

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 appropriate tax year.