Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Declaration *

I want to Gift Aid my donation and any donations I make in the future or have made in the past four years to Bere Regis Congregational Church. I am a UK taxpayer and understand that if I pay less Income Tax and/or Capital Gains Tax than the amount of Gift Aid claimed on all my donations in that tax year it is my responsibility to pay any difference.

I understand *

If I change my name or home address, if i'd like to cancel this declaration, or I no longer pay sufficient tax on your income and/or capital gains I will need to contact Bere Regis Congregational Church. If I pay Income Tax at the higher rate, I must include all my Gift Aid donations on my Self Assessment tax return to receive the additional tax relief due.