EGA Appeal Trust Gift Aid Form

The Elizabeth Garrett Anderson Hospital Appeal Trust 2nd Floor North, 250 Euston Road, London NW1 2PG

Tel: 0845155500 x 72606

Name of Charity: The Elizabeth Garrett Anderson Hospital Appeal Trust Charity Registration Number: Charity No 281153

Details of Donor

Title: ______First name: ______Surname: ______

Address: ______

______

Post Code ______

Tel: Email: ______

Please accept my gift of: £______

I enclose: Cheque Postal Order Caf Voucher - Please make Cheques and Postal Orders payable to - EGA Hospital Appeal Trust.

Gift Aid Declaration By completing this section and returning it to us, you will enable us to claim the tax back on your donation, giving us an extra 25p for every £1 you donate.

I am a United Kingdom taxpayer and I want EGA Hospital Appeal Trust to treat this donation and all donations I make in the future as gift aid donations, until I tell EGA Hospital Appeal Trust otherwise. I pay an amount of Income Tax and/or Capital Gains Tax at least equal to the tax that EGA Hospital Appeal Trust will reclaim on my donations in the appropriate tax year.

Please tick box to validate your declaration. Date ____/____/____ Notes 1. You can cancel this declaration by the tax that the charity reclaims, you can notifying the charity cancel your declaration (see note 1) 2. You must pay an amount of UK income 4. If you pay tax at the higher rate you can tax and/or capital gains tax at least equal claim further tax relief in your Self to the tax that the charity reclaims on Assessment tax return. your donations in the tax year (currently 5. If you are unsure whether your donations 25p for each £1 you give) qualify for Gift Aid tax relief, ask the 3. If in the future your circumstances charity. Or ask your local tax office for change and you no longer pay tax on leaflet IR113 Gift Aid. your income and capital gains equal to 6. Please notify the charity if you change your name and address.

Please tick box if you would like information sent to you about making a regular donation.

Return this form to: The EGA Hospital Appeal Trust Charity, 2nd Floor North, 250 Euston Road, London NW1 2PG

Thank you for your support

The Elizabeth Garrett Anderson Hospital Appeal Trust