GIFT AID DECLARATION

CHARING CROSS HOLIDAY DIALYSIS TRUST (Charity Registration No. 265378) DETAILS OF DONOR NAME:_____________________________________________ ADDRESS: _________________________________________ __________________________________________________ I wish the Charing Cross Holiday Dialysis Trust to treat all donations I make on or after April 6th 2000 as Gift Aid donations. Signed _____________________ Date _______________ ================================================== Notes: 1. You can cancel this declaration at any time by notifying the charity. 2. You must pay an amount of income tax and/or capital gains tax at least equal to the tax that the charity reclaims on your donations in the tax year (currently 28p for each £1 you give). 3. If in the future your circumstances change and you no longer pay tax on your income and capital gains equal to the tax that the charity reclaims, you can cancel our declaration (see note 1). 4. If you pay tax at the higher rate you can claim further tax relief in your Self Assessment tax return. 5. If you are unsure whether your donations qualify for Gift Aid tax relief, ask the charity. Or ask your local tax office for leaflet IR11 Gift Aid. 6. Please notify the charity if you change your name or address.