Date *

Please enter today's date in the format dd/mm/yyyy

Title *

Name *

First

Last

Email Address *

Telephone Number (optional)

Address (Line 1) *

Address (Line2)

City/Town *

Postcode *

Please treat as Gift Aid donations all qualifying gifts of money made (please tick all boxes you wish to apply): *

• Today
• In the past 4 years
• In the future

If you are donating to a specific project or appeal please tick box 1 (Today) above and state the name of the appeal eg “Gift Day 2024” here ….

How will you make your donation? *

• By bank transfer
• By Standing Order
• Through the Church Office
• In a named envelope on the collection plate

Reference (optional)

Please add any reference used when making your donation to help us identify it.

Please tick *

• 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.

Submit

Please notify the charity if you:
1. Change your name or address while the declaration is still in force
2. Wish to cancel this declaration
3. 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.

St Lawrence’s Charity Number: 1127353