Gift Aid Declaration *

Please make a Gift Aid claim for TODAY and IN THE FUTURE

In addition make a Gift Aid claim for the PAST 4 years of donations

Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date *

Please include date you wish to commence Gift Aid claim

MM

DD

YYYY

I am a UK taxpayer and I understand that if I pay less Income Tax and/or Capital Gains Tax than the amount of Gift Aid claimed on ALL my donations to charities and CASCs in that tax year IT IS MY RESPONSIBILITY to pay any difference. *

I confirm

I understand that my gift aid contribution will be claimed by The Charles Simeon Foundation (Registered Address: The Charles Simeon Foundation, Holy Trinity Church, Market Street, Cambridge, England, CB2 3NZ) *

I confirm