East & North Hertfordshire Hospitals’ Charity Gift Aid Declaration Form

Gift Aid Declaration Form

Key criteria for gift aid - please note we can only accept your home address

Title* (required)

First Name* (required)

Surname* (required)

Home Address* (Number, Street, County, Town) (required)

Postcode* (required)

Telephone Number

Date of Declaration* (required)

Please read and confirm the following statements:

This is my own money. I am not paying in a donation made by a third party eg. money collected an event, the pub, a company donation or a donation made by a friend or family member (required)

YES I agree to the above

This donation is not made as part of a sweepstake, raffle or lottery and I am not receiving anything in return for it eg. a book, auction prize, ticket to an event (required)

YES I agree to the above

If you are a UK taxpayers, you can boost your donation by 25p for every £1 you donate. Please tick the box below. (required)

I am a UK taxpayer. Please treat all donations I make or have made to East & North Herts Hospitals Charity for the past 4 years as gift aid donations until further notice. I am a UK taxpayer and understand that if I pay less tax and/or capital gains tax than the amount of gift aid claimed on all my donations in that tax year, it is my responsibility to pay any difference. Please let us know if you want to cancel this declaration, change your home address or no longer pay sufficient tax.

Sign here to give your consent

Date

The East and North Hertfordshire Charitable Fund is a registered charity in England and Wales, registered charity number 1053338

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