

| Details of donor Title.........Forename(s).......................................Surname......................................... Address....................................................................................................................... ...................................................................................................................................... ...................................................................................................................................... ......................................................................Post Code............................................. Email Address............................................................................................................ |
| I want the above charity to treat * the enclosed donation of £.............................. * the donation(s) of £.....................which I made on ..../..../......... * all donations I make after ..../..../........., and until further notice as gift aid donation(s). Signed.......................................................................... Date...................................... * fill in / delete as appropriate |