27824 Mind DD Form A4_SR 11.6.13_Layout 1 13/06/2013 09:57 Page 1
Yes, I would like to help Mind with a regular gift
Instruction to your bank or building
society to pay by Direct Debit
Please fill in the whole form using a ball point pen and return it using
the envelope provided or send to:
Service user number
4 0 7 1 0 4
Mind
Freepost WD2336
London
E15 4BR
Reference
Instruction to your bank or building society
Please pay Mind Direct Debits from the account detailed in this Instruction
subject to the safeguards assured by the Direct Debit Guarantee. I
understand that this Instruction may remain with Mind and, if so, details
will be passed electronically to my bank/building society.
Name(s) of account holder(s)
Bank/building society account number
Branch sort code
Name and full postal address of your bank or building society
Bank/building society
To: The Manager
Signature(s)
Address
Postcode
Date
Banks and building societies may not accept Direct Debit Instructions for some types of account
To make a regular donation by phone, please
call 020 8215 2243 or go to mind.org.uk/donate
Please complete your contact details:
Name:
Address:
Postcode:
Email:*
Please accept my regular gift of £
per month/
quarter/half year/year (delete as appropriate) starting on
3rd/17th (please circle your chosen date) of
(month)/
(year) until further notice.
Tel:*
If your donation is in memory of someone, please tell us their name:
Your relationship to the person being remembered:
*Please stay in touch: Thank you for your support. It really makes a difference. As a charity we’d like to contact you from time to time to tell you more about our work,
fundraising and campaigns. It’s often cheaper for us to contact you by email or SMS, and allows us to spend more money on charitable activity. If you’re happy for us to contact you
this way, please tick the relevant boxes to let us know (you can tick more than one): By email
By SMS
We’d still like to contact you the more traditional ways, but if you’d prefer that we didn’t, again just let us know by ticking the relevant boxes: By post
By phone
Don’t worry, you can unsubscribe at any time and we won’t send you spam or junk mail or give your details to anyone else.
Gift Aid allows Mind to claim tax back from HMRC on all your donations. For every £1
you give, they'll add an extra 25p from your taxes and it doesn't cost you a penny.
Please tick here
Today’s date:
/
I am a UK taxpayer and I would like Mind to treat all donations I have made for the four years prior to this tax year and all donations I make from the date
provided, until I notify you otherwise, as Gift Aid donations. I understand that I must have paid an amount of income tax and/or capital gains tax at least
equal to the tax that all charities or Community Amateur Sports Clubs (CASCs) will reclaim on my donations for that tax year. Please note that VAT and
Council Tax do not qualify to cover Gift Aid claims.
Please return this form using the envelope provided or send to: Mind, Freepost WD2336, London, E15 4BR
/
Thank
you
$
FUNDL
This guarantee should be detached and retained by the payer.
The
Direct Debit
Guarantee
• This Guarantee is offered by all banks and building societies that accept instructions to pay Direct Debits
• If there are any changes to the amount, date or frequency of your Direct Debit Mind will notify you 10 working days in advance of your account being debited or as
otherwise agreed. If you request Mind to collect a payment, confirmation of the amount and date will be given to you at the time of the request.
• If an error is made in the payment of your Direct Debit, by Mind or your bank or building society, you are entitled to a full and immediate refund of the
amount paid from your bank or building society – If you receive a refund you are not entitled to, you must pay it back when Mind asks you to
• You can cancel a Direct Debit at any time by simply contacting your bank or building society. Written confirmation may be required. Please also notify us.