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To The Manager (name and address of your Bank or Building Society)
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Please pay to Barclays Bank plc (20-72-89), 36-38 South Street, Romford, Essex RM1 1RH for the credit of LUPUS UK (Account No. 60575704) Registered Charity No. 1051610
the sum of £...............................per month/quarter/year (delete as appropriate)
commencing on ...................... day of ............................ year ......................
UNTIL SUCH TIME AS I CANCEL THIS INSTRUCTION IN WRITING
Signed..............................................................................................
Full Name:........................................................................................
Address:..............................................................................................................
............................................................................................................................
Postcode: .......................................
DO YOU REQUIRE MEMBERSHIP WITH THIS DONATION? (Currently £10 per annum)
YES/NO (delete as appropriate)
Please complete Gift Aid declaration below if you wish this donation to be taken as a gift aid payment and you are a tax payer.
GIFT AID DECLARATION
Name: ..........................................................................................................
Address: .......................................................................................................
.....................................................................................................................
Post Code: .................................
I want LUPUS UK to treat
* the enclosed donation of ..........................
* all donations I make from 6th April, 2000
as Gift Aid Donations. *delete as appropriate
Signature..........................................................................................
Date: ......................................................
I confirm I pay an amount of income tax and/or capital gains tax at least equal to the tax that the charity reclaims on my donations in the tax year (currently 25p per £1, plus a Government supplement of 3p per £1 until 5th April 2011)
Please return this form to: LUPUS UK, St James House, Eastern Road, Romford, Essex RM1 3NH
Tel: 01708 731251 Fax: 01708 731252 |
