DONATION/PLEDGE FORM
AND GIFT AID DECLARATION
Please print this form, complete it and send it to the address below.

Name of Donor....................................................................................................

Address of Donor.................................................................................................

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

..........................................................Post Code ................................................

Please select the relevant option:

1. I enclose my donation of.....................................£............................................

2. I wish to pledge the following amount which
I will forward to the Parish Office when requested........£..........................................

3. I wish to donate the following amount by
monthly standing order over 12 or 24 months
which I may cancel at any time.................................£..........................................

If you are a UK taxpayer and would agree to Gift Aid your donation (without any additional cost to yourself) please complete the following declaration:

• Please treat my donation as a Gift Aid Donation
• I understand that I will have paid an amount of income or capital gains tax at least equal to the tax that the Church will reclaim in the relevant tax year (currently 28p for each pound donated)

N.B. If you pay tax at the higher rate you may be able to claim further tax relief on your Self Assessment tax return.  If you are unsure whether your donation qualifies for Gift Aid tax relief please seek advice from the Parish Office.

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

Date .........................................................

I request that my donation is recorded in the St Andrew's Gift Register

in loving memory of..........................................................................

name and relationship (e.g. My Mother) ..............................................

Please print this form, complete it and return the completed form to the Revd Udobata Onunwa Parish Office, St Andrew's Church, 37 Lime Grove, Runcorn, Cheshire. WA7 5JZ (01928 574411)