THE FRIENDS OF ST LAURENCE’S WYCK RISSINGTON

Name of Charity

Friends of St Laurence’s Wyck Rissington Building Trust: Registered No 1118594

Details of donor

Title……..Forename(s)…………………………............... Surname………………………………………………..

Address…………………………………………………………………………………………

….…………………………………………………………………………………………………

…...…………………………………………………………….

Post Code…………………………………………………….

I want the charity to treat the enclosed donation of £……………… as a Gift Aid donation

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 appropriate tax year.

Signature …………….. ………………….     Date………./………./……….

NOTES

1. You can cancel this Declaration at any time by notifying the charity.

2. 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.

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

4. I you are unsure whether your donations qualify for Gift Aid tax relief, ask the charity. Or, refer to help sheet IR65 on the HMRC web site. (www.hmrc.gov.uk)

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

When completed please return to:

The Treasurer, Friends of St Laurence’s, Greenfields Farm, Wyck Rissington, Cheltenham, Gloucestershire GL54 2PN