Print this form by clicking on 'print' in the file menu on the toolbar of your browser, fill in your details and send it to us at the centre and your donation is worth 28% more to the centre because we can reclaim your tax.

 

Gift Aid Declaration

Full Name

Address
 

Post Code

I declare my intention that tax should be reclaimed on all donations I make to the Sussex Multiple Sclerosis Treatment Centre from 6th April 2000. I understand that I must pay enough Income Tax or Capital Gains Tax in each year to cover the amount to be reclaimed.

Signed

Dated
  1. You must be a UK tax payer, resident in the UK for tax purposes.
  2. You must inform the centre if you cease to pay sufficient tax, otherwise you will be required to refund the Inland Revenue.
  3. Your donation must not be based on the tax paid by another person, but you alone.
  4. You are entitled to cancel this Declaration at any time by notifying the Therapy Centre in writing. Unless you do so, the Centre will continue to reclaim tax on all your giving.

How do you wish to proceed?

*I wish to make a ‘one off’ donation by cash or cheque.

*I wish to commence a regular Standing Order.

*This is a general declaration covering my future therapy donations.

*Please delete as appropriate.

You will be given a ‘Gift Aid Number’ when you return this form. This must be written on the back of any cheques subsequently donated. Please place cash or cheques in an envelope which must also show your Gift Aid Number.

Standing Order Mandate

To the Manager (Bank Name)

Address

Post Code

Account Number

Sort Code

Please debit my/our account monthly/quarterly/annually by the sum of £___________

Commencing on_________________until further notice.

Please credit Lloyds TSB, Southwick Branch in the name of the Sussex Multiple Sclerosis Treatment Centre. Account Number: 01813557 Sort Code: 30 98 74.

Signed

Dated

Please return to:

The Sussex Multiple Sclerosis Treatment Centre
Southwick Recreation Ground
Croft Avenue, Southwick
West Sussex
BN42 4AB