Gift Aid Declaration

Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Declaration *

I would like St Mary's East Molesey PCC (Charity no 1197566) to reclaim the tax on this and any other eligible donations that I may make in the future or have made in the past 4 years. I understand that I need to pay enough Income Tax or Capital Gains Tax in each tax year to cover the Gift Aid claimed on all my donations otherwise it is my responsibility to pay any difference. I understand the charity will reclaim 25p of tax on every £1 that I give.

Yes (Tick box to agree to declaration)