Hospital Rooms Recurring Donation Form

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Help support Hospital Rooms. Please add Gift Aid at no extra cost, so that we can claim tax back from the government

I want to Gift Aid any donations made to Hospital Rooms now, in the future and in the past four years. I am a UK taxpayer and I understand that if I pay less Income and/or Capital Gains Tax than the amount of Gift Aid claimed on all my donations in the relevant tax year, it is my responsibility to pay any difference. We will always act on your final Gift Aid choice
Your Name

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Recurring Name
Instalment Period
Day of Month
Monthly Calculated Amount
Annual Calculated Amount
Monthly Amount
Annual Amount
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Effective Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Effective Date2

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Membership Level
Payments
prevnext( X )
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Annual
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