FRIENDS OF ROOTS AND SHOOTS
MEMBERSHIP FORM for April 2014 to 2015 /
Walnut Tree Walk
SE11 6DN
020 7587 1131
Please complete the relevant details:
I am a new member
I am an existing member / Number:
Name:
Address:
Postcode:
Telephone No: / Mobile No:
Email address:
Date:
Subscription/Donation (please tick / Cheque/Cash
Single person / £15.00
Senior citizens, students etc / £5.00
Family/couple / £20.00
Extra Donation / £
Subscriptions are renewed each April.
Please make cheques payable to FRIENDS OF ROOTS AND SHOOTS and send to Friends of Roots and Shoots, Walnut Tree Walk, London SE11 6DN
GIFT AID; if you are a UK tax payer, we can reclaim the tax if you make a donation. If this is applicable, please complete and sign the form overleaf and return it with your cheque.
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Helpers are always needed at events such as the seasonal open days, in the shop, at plant sales, in the wildlife garden, working with trainees and for special projects such as apple pressing. If you have some time – however little – to spare, we would love to hear from you. If you are happy for us to contact you to see if you might be able to help from time to time, please tick this box.
From time to time special skills and expertise are needed at Roots and Shoots, from IT and accounting help, to legal and health and safety advice. If you have a skill you might like to share, please let us know. Please contact on the email addresses here:
Kerry Hill or Issy Okonta or 020 758 71131
Roots and Shoots is a company limited by guarantee, registered in England and Wales No 3400781
Registered Charity No 1064070/0
Roots and Shoots
GIFT AID DECLARATION /
Name of Charity: / Roots and Shoots
Charity No: / 1064070/0
Details of donor
Title: / First name(s): / Surname:
Address:
Postcode:
I want the charity to treat (please delete as appropriate)
The enclosed donations of £………………………………………………….
All donations I make from the date of this declaration until I notify you otherwise
All donations I have made since 6 April 2000, and all donations I make from the date
of this declaration until I notify you otherwiseas GIFT AID DONATIONS
Notes:You are a UK tax payer if; tax is taken from your wages/salary, you pay under self-assessment, you have taxable savings e.g. A pension plan or you have paid Capital Gains tax recently.
  1. 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 (currently 20% for each £1 you give).
  2. You can cancel this declaration at any time by notifying the charity.
  3. 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 (see note 1).
  4. If you pay tax at the higher rate, you can claim further tax relief of 20% in your Self-Assessment tax return.
  5. If you are unsure whether your donations qualify for Gift Aid tax relief, ask the charity, or ask your local tax office for leaflet IR65.
  6. Please notify the charity if you change your name or address.

I hereby declare that I am a tax payer
SIGNATURE: / DATE
Roots and Shoots
STANDING ORDER MANDATE /
To save you time sending us a cheque every year, you could pay by Standing Order. The amounts and dates are clearly specified below by you and cannot be changed by anyone other than you.
To the Manager:
BANK NAME:
BRANCH ADDRESS:
POST CODE:
Please pay from my account;
ACCOUNT NAME:
ACCOUNT NO:
SORT CODE:
AMOUNT TO BE PAID:
Individual£15 / Concessions£5
Family/couple £20 / Donation £
TOTAL AMOUNT / £
Date of first payment: On receipt of this mandate and thereafter on the first day of April each year until I cancel this mandate.
Signed: / Date:
BENEFICIARY’S BANK WHERE PAYMENTS TO BE MADE
NAME: / Roots and Shoots
BANK: / CAF Bank Ltd
BRANCH: / Kings Hill
SORT CODE: / 40 52 40
ACCOUNT NO: / 00009466
Please send this completed form to Friends of Roots and Shoots, Walnut Tree Walk, London, SE11 6DN. We will forward it to your bank.
Many thanks.