Gift Aid Declaration

To: Heshima, Katy Rowe, 6 Glan Aber Park, Chester, CH4 8LF

Please reclaim the tax on all donations I have made to Heshima since

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(above date should not be earlier than 07/07/2008)

and on all donations I make hereafter. Please treat my donations as Gift Aid

I understand that it is a requirement that I must pay an amount of income tax and/or capital gains tax equal to (or more than) the amount that Heshima reclaims on my donations.

Signed & delivered

Date

Title

Full Name

Address

Postcode

N.I Number

(National Insurance Number assists in reclaiming tax)

Please tick if you would like to be kept informed on Heshima’s work:

Would you prefer us to contact you through the post? or e-mail?

If e-mail, please give your e-mail address:

Notes for Donors

You must pay an amount of income tax and/or capital gains tax equal to (or more than) the amount that Heshima reclaims on your donations. (For 2008 this is 25p for each £1 you donate)

You can cancel this declaration at any time by notifying the Treasurer.

If your circumstances change and you no longer pay income tax and/or capital gains tax equal to that being claimed, you should notify the Treasurer. No explanation is required.

Please also notify the Treasurer if you change your name or address while this declaration still applies.

It is a requirement that all donations on which tax is reclaimed are in a traceable form. This means by cheque, standing order or by cash for which a receipt is issued. Tax cannot be reclaimed on loose cash which has been given without a receipt.

Confidentiality is assured so that any donation may be considered anonymous to all other than the Heshima Secretary and Treasurer.

If you are a higher rate taxpayer you can claim further tax relief via your self-assessment return.

Data Protection Act. No information given on this form will be passed to any third party other than the Inland Revenue, and that solely for the purpose of reclaiming tax in accordance with the instructions given.