Please complete all the relevant sections of the following form, print it, sign it where applicable, and send it to:
Devon Air Ambulance Trust, Unit 5 Sandpiper Court, Harrington Lane, Exeter, Devon EX4 8NS. Telephone: 01392 466666
IMPORTANT NOTE BEFORE PRINTING: Due to the width of the forms in this page we recommend printing to landscape (horizontal). To do this go to File and Page Setup in your web Browser and choose Landscape under the Orientation option.
Section 1 - Please complete fully
Title
Dr Mr Mrs Miss Ms
Full Name
Address
Postcode
Telephone
E-mail
Signed
Date
I am a tax payer and wish the charity to claim Gift Aid on my donation (If ticked, please also complete the section at the bottom of this form for Gift Aid Declaration).
Section 2 - Please complete if you are making a one-off donation (please tick appropriate boxes):
I would like to make a one-off donation of:
£ (figures)
£ (words)
by cheque (enclosed)
by credit card please complete the following details:
Name of card holder
Credit card No
Issue No (if any)
Expiry
/
Section 3 - Please complete if you wish to make a regular donation by standing order:
To:
(Your bank's name)
Postal Address:
(Yourbank's address)
Bank:
Branch:
Sorting Code:
Please Pay :
HSBC
St. Thomas, Exeter
40-20-29
Creditor
Account Number:
Quoting Reference:
For the credit of:
Devon Air Ambulance Trust
51363492
Amount:
Amount in words:
The sum of:
£
Date of first payment:
and thereafter every:
Due date and frequency:
until further notice in writing or:
Date or last payment:
and debit my/our account accordingly
Commencing:
PLEASE CANCEL ALL PREVIOUS STANDING ORDER/DIRECT DEBIT MANDATES IN FAVOUR OF:
UNDER REFERENCE NUMBER:
If there are any special instructions please tick this box and enter them opposite:
Name of account to be debited:
Sorting code:
Account number:
Signature(s):
Date:
Banks may decline to accept instructions to charge Standing Orders to certain types of accout other than Current Accounts
Note: The Bank will not undertake to:
a) make any reference to Value Added Tax or pay a stated sum plus VAT or other indeterminate element. b) advise remitter's address to beneficiarry c) advise beneficiary of inability to pay d) request beneficiary's banker to advise beneficiary of receipt e) accept instructions to pay as soon after the specified date as there are funds to meet the payment. If funds are not available on the specified date.
Payments may take 3 working days or more to reach the beneficiary's account. Your branch can give further details.
Data Protection Act I am am not happy for the Devon Air Ambulance Trust to send me further details. I am am not happy for Devon Air Ambulance Trust to pass my details to organisations that might be of interest to me.
FOR BANK USE ONLY
Please quote the following reference:
Gift Aid Declaration
Details of Donor:
Title
Dr Mr Mrs Miss Ms
Name
Address
Postcode
Telephone
E-mail
A. I would like the charity to treat the following as Gift Aid donations: (please tick all statements that apply)
1. All donations that I have made since 6 April 2006, and all donations I make from the date of this declaration until I notify you otherwise.
2. The donation(s) of £ which I made on (enter date)
3. The donation(s) of £ which is enclosed.
B. If you are NOT a taxpayer please provide details below:
1. I am temporarily a non-taxpayer for the years to
2. I am permanently a non-taxpayer from the year
Date:
Signature:
You can cancel this declaration at any time by notifying the charity.
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 £1 you give)
If in the future your circumstances change and you no longer pay tax on your income and capital gains equal to the tax the charity reclaims you can cancel the 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. Or ask your local tax office for leaflet IR113 Gift Aid
Please notify the charity if you change your name or address
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