IF SPACE INSUFFICIENT, USE REVERSE SIDE. Total Pledge/Donation $ 0.00/Yr

Name Department/Organization Work Address

METHOD OF DONATION: VERIFIED BY CANVASSER: Payroll Deduction: Cash: I authorize my employer to deduct the payroll pledge, either one-time or consecutively for 26 pay periods (or until revoked by me in writing), and remit on my Cash $ 0.00 /yr behalf. The deduction will start in January of the New Year. Bi-weekly payroll deduction $ 0.00 x 26 = $ 0.00 /yr Cheque $ 0.00 /yr (payable to All Charities Campaign or charity(ies) of choice) One-time payroll deduction $ 0.00 /yr (from first pay cheque in January) Online payroll pledge (for ME users of the GOM only; Note: Official tax receipts for cash/cheque donations of less than $10 issued upon request. access https://web30.intranet.mbgov.ca/AllCharitiesWeb; check box if pledge made online; return form to canvasser) Note: Payroll donation will appear on your T4 slip.

Direct your gift by listing the charity(ies) below. Visit www.allcharitiescampaign.ca to view the listing of charities that have been supported by All Charities donors. You may use the code by each charity instead of writing the name out in full. If you wish to notify the charity(ies) of your donation, please check off the charity(ies) to be notified and complete the RELEASE OF INFORMATION section below.

0.00 /yr $ 0.00 /yr $ 0.00 /yr $ 0.00 /yr $ 0.00 /yr $ 0.00 /yr $ IF SPACE INSUFFICIENT, USE REVERSE SIDE. Total Pledge/Donation $ 0.00/yr

Signature: Date: (Please sign to confirm your gift.) RELEASE OF INFORMATION (information will be released to the agency when the donation is actually paid): In accordance with the Freedom of Information and Protection of Privacy Act, I hereby authorize the release of the information noted below to the agency(ies) checked off above. Please provide the agency(ies) with the following:

Name and amount of donation.

Name, e-mail or mailing address and amount of donation. E-mail or mailing address City

Please ask the agency to add me to their mailing list. Postal code Office Phone Number (For Campaign Office use only) Giving and Tax Savings Benefits Your donation will result in a non-refundable tax credit. This table represents your savings. Bi-weekly Annual Contribution Provincial Tax Credit Federal Tax Credit Net Cost $2 $52 $5.62 $7.80 $38.58 $4 $104 $11.23 $15.60 $77.17 $10 $260 $32.04 $47.40 $180.56 $15 $390 $54.66 $85.10 $250.24 $20 $520 $77.28 $122.80 $319.92