Friends of Bassetlaw Hospice Donation Form

Sign-up Form

Title

Name

Address

Phone number

Email

Amount to donate

Donate monthly or yearly?

Monthly

Yearly

Gift Aid?

Please tick to treat this ongoing donation as Gift Aid

Gift Aid is reclaimed by the charity from the tax you pay for the current tax year.

I am a UK taxpayer and understand that if I pay less Income Tax and/or Capital Gains Tax than the amount of Gift Aid claimed on all my donations in that tax year it is my responsibility to pay any difference.

Please notify the charity if you:

Want to cancel this declaration
Change your name or home address
No longer pay sufficient tax on your income and/or capital gains

If you pay Income Tax at the higher or additional rate and want to receive the additional tax relief due to you, you must include all your Gift Aid donations on your self assessment tax return or ask HM Revenue and Customs to adjust your tax code.

Verification

We do not support SPAM and we would never sell your information to anyone. Any correspondence is strictly confidential. We will only use the above information to contact you about your donation.