Erasmus Darwin House

Print the page out by using the PRINT FORM button below, which will just print the relevant part of this page. Then post it, including your payment if paying by cheque, with this Gift Form.

Gift Aid Form - Name of Charity: ERASMUS DARWIN FOUNDATION

Registered Charity No: 1063528

Details of Donor

Title: .......... Forenames: ............................. Surname: ................................

Address :
.......................................................................

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

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

Post Code :
................................

I want the Charity to treat

All donations I make from the date of this declaration until I notify otherwise

All donations I have made since April 6th, 2004, and all future donations I make from the date of this declaration until I notify otherwise

The enclosed donation of Ł ..........................

The donation(s) of Ł ................ which I made on .... / .... / ....

As Gift Donations Please tick as appropriate

Signature: ..................................................... Date ..... / ..... / .....

ERASMUS DARWIN FOUNDATION

Gift Aid Form - NOTES

If your declaration covers donations you may make in the future:

Please notify the Charity Treasurer if you change your name or address while the declaration is still in force.

You can cancel the declaration at any time by notifying the Charity Treasurer - it will then not apply to donations you make on or after the date of cancellation or such later date as you specify.
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 tax year (currently 28p for each Ł1 that you donate).
If in the future, you circumstances change and you no longer pay Tax on your Income and Capital Gains equal to the Tax that the Charity reclaims, you will need to cancel your declaration (see note 1).
If you pay Tax at the higher rate, you can claim further Tax Relief in your Self Assessment Tax Return.
If you are unsure whether your donations qualify for Gift Aid Tax Relief, ask the Charity Treasurer, or you can ask your local Tax Office for leaflet IR113 Gift Aid.

Send this Gift Aid Form to the Charity Treasurer, together with your donation/subscription, and keep a copy for your own records.

Address for correspondence:
The Treasurer
ERASMUS DARWIN FOUNDATION
Beacon Street
Lichfield
Staffordshire WS13 7AD

ERASMUS DARWIN HOUSE
Beacon Street, Lichfield, Staffordshire WS13 7AD
Tel: 01543 306260 Fax: 01543 306261
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