St. Helen’s Church, Dry Sandford BANKER’S ORDER: (Optional): only for those choosing automatic payment by Standing Restoration Fund Pledge Form Order. You can change your Standing Order at any time by informing the PCC Treasurer Your support will help re-open the Church. Thank you! (email: [email protected]). Please make sure you’ve also completed the Gift Aid Declaration if you are a UK taxpayer. www.sthelensdrysandford.org Return to: (email) [email protected] or by post/delivered to: Josephine To the Manager: ……………..…………………………………….………………… Bank plc Cross (Church Warden), Lashford House, Church Lane, Dry Sandford, OX13 6JP, or to Address: ……………………………..………………………………………………………………………….………………… Marisa Goodenough (Deputy Warden), 65 Lashford Lane, Dry Sandford, OX13 6DZ Please pay: The PCC of Dry Sandford At: Barclays Bank, Marcham Road, Abingdon. OX14 1UB I intend to give a total of £ ……………………………….. Account Number: 50717533 ❑ As a single gift ❑ As…………….payments in total made (check box below) Sort Code: 20-01-09 ❑ Monthly ❑ Other frequency …………………………….. Quote Reference: SHDS Restoration

I would like to make my gift by (check box below): Tell us how you’d like to divide your total payments and frequency below ❑ Cash/cheque (please circle): Cheques made payable to The PCC (Parochial Church The sum of £ …………………….…….… (figures) …..……….………………………………………… (words) Council) of Dry Sandford ❑ Automatic giving by Standing Order (please complete Banker’s Order Section). Commencing on the: …………………….. Day of ………..………...………. (month) 20…………(year) and on the same day in each month / quarter / year YOUR CONTACT INFORMATION & GIFT AID DECLARATION: Personal Data Privacy and Protection Statement: We are collecting your contact and financial details for tax and legal purposes and to reply to your until ……………………………….………….(date) or until further notice (Delete as applicable). donation as appropriate. We will not share your contact information outside of this purpose without your consent and will keep your details secure. Full Name: …………….…………………………………………………..………….………..………………….. Title: …………………… First Name: ……………..……..………………………………………………………………. Address: ……….……….……………………….…………….…………………………………………………….. Surname: ………………………………………………………………………………………………………………………… ……………………………….…………… Post Code: ..……………………………………….….………....…. ❑ Yes, I am happy to have my name listed as a donor on any public material ❑ I wish to be listed as anonymous on any public material Account Name: …………………..………………………………….……………………..…….……………..

Address: ……………….…………………………………………………….…………………..………………...……………. Sort Code:…………………….……………Account Number: …….…….……..……………..…….….. …………………………………………………………………………………..…………………..……………………………..… Signature: ……………………………..………………………….………………………..…………. Post Code: …………………………………….………. Tel (optional): ………………..…………………….…….…. Date: …………………………………..………..…....………….. ======Email (optional): …………………………………………………………….………………………………………………… Additional instructions Gift Aid Signature: ………………………………………………..…..……..……. Date: …….…….…....………….. ❑ Please contact me regarding additional instructions Please keep me informed of progress by: ❑ Post ❑ Email ❑ Both ❑ Please contact me to discuss legacy giving. I would like to know more about leaving funds to St. Helen’s Church in my will. ❑ GIFT AID DECLARATION (Please check box, complete full name, address and sign above if you are a UK Taxpayer! This significantly helps us by allowing St. Helen’s to Note: In the unlikely event the restoration project is not successful, any residual privately reclaim 25p of tax on every £1 of your donation!). I am a UK taxpayer, and I want the collected funds will be equally split and transferred to the Dry Sandford Primary School Church to reclaim the tax on all donations made to the PCC from the date of this and the Oxfordshire Historic Churches Trust. declaration until informed otherwise. I will inform the Church if I don’t pay an amount of tax that at least equals the tax deducted from this donation.