Event name:
Registered Charity No. 702490
Title:
Organisation name (if appropriate):
First name:
Last name:
Home address:
Postcode:
Phone:
Email:
For every £1 you give, we get an extra 25 pence from the
Government, at no extra cost to you.
Please read and sign the declaration below if you qualify.
Making your gift go even
further
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If I have ticked the box headed ‘Gift Aid? √’, I confirm that I am a UK Income or Capital Gains
taxpayer. I have read this statement and want Headway Worcestershire to reclaim tax on the
donation detailed below, given on the date shown. I understand that if I pay less Income Tax /
or Capital Gains tax in the current tax year than the amount of Gift Aid claimed on all of my
donations it is my responsibility to pay any difference.
I understand the charity will reclaim 25p of tax on every £1 that I have given.
Please make
sure you
clearly mark
with a
tick "✓" if you
agree to Gift
Aid
or with an "X"
if you do not.
Date
Title
First name
Last name
Home address
Postcode
Amount
Email address
Agreed to
Gift Aid ✓/
X
12/02/2016
Mrs
Joanne
Smith
1 Gregory's Mill Street, Worcester
WR1 2PY
£25
[email protected]
✓
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Date
Title
First name
Last name
Home address
Postcode
Amount
Email address
Agreed to Gift
Aid ✓/ X
12/02/2016
Mrs
Joanne
Smith
1 Gregory's Mill Street, Worcester
WR1 2PY
£25
[email protected]
✓
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Date
Title
First name
Last name
Home address
Postcode
Amount
Email address
Agreed to Gift
Aid ✓/ X
12/02/2016
Mrs
Joanne
Smith
1 Gregory's Mill Street, Worcester
WR1 2PY
£25
[email protected]
✓
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Date
Title
First name
Last name
Home address
Postcode
Amount
Email address
Agreed to Gift
Aid ✓/ X
12/02/2016
Mrs
Joanne
Smith
1 Gregory's Mill Street, Worcester
WR1 2PY
£25
[email protected]
✓
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Date
Title
First name
Last name
Home address
Postcode
Amount
Email address
Agreed to Gift
Aid ✓/ X
12/02/2016
Mrs
Joanne
Smith
1 Gregory's Mill Street, Worcester
WR1 2PY
£25
[email protected]
✓
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Date
Title
First name
Last name
Home address
Postcode
Amount
Email address
Agreed to Gift
Aid ✓/ X
12/02/2016
Mrs
Joanne
Smith
1 Gregory's Mill Street, Worcester
WR1 2PY
£25
[email protected]
✓
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Date
Title
First name
Last name
Home address
Postcode
Amount
Email address
Agreed to Gift
Aid ✓/ X
12/02/2016
Mrs
Joanne
Smith
1 Gregory's Mill Street, Worcester
WR1 2PY
£25
[email protected]
✓
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Date
Title
First name
Last name
Home address
Postcode
Amount
Email address
Agreed to Gift
Aid ✓/ X
12/02/2016
Mrs
Joanne
Smith
1 Gregory's Mill Street, Worcester
WR1 2PY
£25
[email protected]
✓
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Date
Title
First name
Last name
Home address
Postcode
Amount
Email address
Agreed to Gift
Aid ✓/ X
12/02/2016
Mrs
Joanne
Smith
1 Gregory's Mill Street, Worcester
WR1 2PY
£25
[email protected]
✓
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Date
Title
First name
Last name
Home address
Postcode
Amount
Email address
Agreed to Gift
Aid ✓/ X
12/02/2016
Mrs
Joanne
Smith
1 Gregory's Mill Street, Worcester
WR1 2PY
£25
[email protected]
✓