Gift Aid Declaration Form

Registered Charity Number 1129435

Gift Aid Declaration

I wish to Gift Aid my donation of £ Amount* and any donations I make in the future or have made in the past four years to St Marylebone Parish Church **

Are you a UK Taxpayer?*

Yes, 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.

Title*

First Name*

Last name*

Full Home Address*

Home Address Continued

Postcode*

Date*

Signature*

I will notify St Marylebone Parish Church

If I want to cancel this declaration.
If I change my name or home address.
If I no longer pay sufficient tax on my income and/or capital gains.

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

St Marylebone Parish Church, 17 Marylebone Road, London, NW1 5LT

020 7935 7315

www.stmarylebone.org

** The Parochial Church Council of the Ecclesiastical Parish of St Marylebone with Holy Trinity St Marylebone

Registered Charity Number 1129435