HOSPICE AT HOMEWEST CUMBRIA

[Registered Charity No. 1086837]

Gift Aid Declaration
Details of donor
Title: Mr / Mrs / Miss / Other ….…… [Delete as appropriate]
Forename(s) …………………………………… Surname ………………..…………..
Address ………………………………………………………………………….………..
……………………………………………………………………………………....
………………………………………………… Post Code ………………….….
Tel No ………………………………………………………………………….…………..
E-mail Address………………………………………………………………….………..
I wishHospice at HomeWest Cumbriato treat
*the enclosed donation of £ ……………….
*the donation(s) of £ ………………………which I made on ……/……/……..
*all donations I make from the date of this declaration until I notify you otherwise
*[Delete as appropriate]
as Gift Aid donations.
I declare that I will be paying an amount of Income Tax and/or Capital Gains Tax for each tax year (6 April one year to 5 April the next) that is at least equal to the amount of tax that will be reclaimed on all the donations I plan to make in that tax year.
Signature ………………………………………………….…... Date …………..………..
Please return completed form to: Hospice at Home West Cumbria
Upper Floor, Cumbria House
New Oxford Street
Workington
Cumbria CA14 2NA
Please read Notes overleaf

Notes

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 tax year.

Hospice at Home West Cumbria will reclaim 25p of tax on every £1 you give.

You can cancel this declaration at any time by notifying the charity in writing.

If in the future your circumstances change and you no longer pay tax on your income and capital gains equal to the tax that the charity reclaims, you can cancel your declaration.

If you pay tax at the higher rate you can claim further tax relief in your Self- Assessment tax return.

If you are unsure whether your donations qualify for Gift Aid tax relief, please call the Fundraising Office on (01900) 873173 or ask your local tax office for guidance.

Please notify the charity if you change your name or address.