Gift Aid Declaration

Friends of Mulanje Orphans (FOMO)

DECLARATION: I confirm that I am a UK taxpayer and authorise the Trustees of the charity to recover IR Tax on this donation and all other donations given to the charity. (Please tick as appropriate) Please Return the completed form to: FOMO, 29 Liverpool Old, Road, Walmer Bridge Preston Lancs. PR4 5QA

Income Tax on my SINGLE Gift of:

£

Date:

and / or MONTHLY Donation of:

£

Date From:

Title:

Mr.

Mrs.

Ms.

Dr.

Rev.

Other

Please complete in BLOCK CAPITALS:

Family Name:

First Name:

Address:

_______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________

The way it works: The charity can claim IR Tax back to the value of the personal tax you have paid in any one year. The charity can only claim back the standard rate of tax. Higher rate tax payers can claim back the difference between the standard and higher rate tax.

Post Code

Tel No:

Email Address:

Signature:

Date:

Office Use Only - FOMO Treasurer:

Family Name:

Woodworth

First Name:

Mary

Address: 29 Liverpool Old, Road, Walmer Bridge Preston Lancs. PR4 5QA

Charity IR Code:

XR 57596

Charity No:

1090727

Account Details:

Account Name:

Friends of Mulanje Orphans

Bank Sort Code:

30-96-85

Account Number:

2394580

Bank Address:

Lloyds TSB Bank plc, 94, Fishergate, Preston, PR1 2JB