Gift Aid Declaration

Charity Gift Aid Declaration

Boost your donation by 25p of Gift Aid for every £1 you donate
Gift Aid is reclaimed by the charity from the tax you pay for the current tax year
Your name & home address is needed to identify you as a current UK taxpayer

To Gift Aid your donation you must complete all fields and select the option YES in the box below:

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 want to Gift Aid any current donation and any donations I make in the
future or have made in the past 4 years to
Guillain-Barré & Associated Inflammatory Neuropathies (GAIN):
YesNo

Date of declaration (DD/MM/YYYY):*

Your name
Your title:*

Your first name:*

Your surname:*

Your home address
House name or number and road:*

Town or city:*

Postcode:*

Your email (so we can get back to you if we need to check information provided):*

I have made a donation via JustGiving:
YesNo

If you have answered YES, please supply your JustGiving payment reference so we can claim Gift Aid on your donation
My JustGiving payment reference is:

Please notify the charity if you:
• want to cancel this declaration
• change your name or home address
• no longer pay sufficient tax on your income and/or capital gains

If you pay Income Tax at the higher or additional rate and want to receive
the additional tax relief due to you, you must include all your Gift Aid
donations on your Self-Assessment tax return or ask HM Revenue and
Customs to adjust your tax code.

I am happy to be contacted about your work and appeals via email:
YESNO