Donor’s Full Name (in CAPITALS) .........................................................

Donor’s Title: Mr/Mrs/Miss/Ms/Dr/Prof ..................................................

Donor’s Address (in CAPITALS) ..........................................................

..............................................................................................................................

.......................................................... Postcode ..........................

I want the Society to treat all donations I have made since 6th April 2000 and all donations I make from the date of this Declaration, until I notify you otherwise, as Gift Aid Donations.

Signature of Donor: .........................................................

Date of Signing: .................................

Notes:

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

2. You must pay an amount of Income Tax and/or Capital Gains Tax at least equal to the tax that the society reclaims on your donations in the tax year (currently 28p for each £1 that you give).

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 Society reclaims, you should cancel your declaration. (See Note 1 above)

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

5. Please notify the Society if you change your name and address.