Foundation (UK) Limited Gift Aid Declaration Form A Registered Charity, Registered in England and Wales Registered Office Address: 19 Norcott Road, London N16 7EJ, United Kingdom Registered Charity Number: 1146770 Company Registration Number: 07960219

Title

Forename(s)

Surname Address

Telephone

E-mail

Please treat as Gift Aid donations all qualifying gifts of money made: (please tick all boxes you wish to apply) today

in the past four years

in the future

I am a UK taxpayer and understand that if I pay less Income Tax and/or Capital Gains Tax in the current tax year than the amount of Gift Aid claimed on all my donations it is my responsibility to pay any difference. I understand the charity will reclaim 25p of tax on every £1 that I give from today onwards.

Signature

Date

Notes: 1. If your declaration covers donations you may make in the future: Please notify the Foundation if you change your name or address while the declaration is still in force. You can cancel the declaration at any time by notifying the Foundation. It will not apply to donations you make on or after the date of cancellation or such later date as you specify. 2. You must pay an amount of income tax and/or capital gains tax at least equal to the tax that the Foundation reclaims on your donations in the tax year (currently 25p for every £1 you donate). If you are not a UK taxpayer, then please notify us as soon as possible at the address shown above. This notification should be made within 30 days of receipt of this form. 3. If your circumstances change and you no longer pay tax on your income and capital gains equal to the tax that the Foundation reclaims, you can cancel your declaration (see note 1). 4. 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 rate.

Attn: Eileen Flood, Administrator HCFL, 19 Norcott Road, London N16 7EJ, United Kingdom Tel. 020.7502.2813 • [email protected]

[rev. 29 February 2016]

Haverford College Foundation (UK) Limited: Gift Aid Declaration ...

Page 1 of 2. Foundation (UK) Limited. Gift Aid Declaration Form. A Registered Charity, Registered in England and Wales. Registered Office Address: 19 Norcott Road, London N16 7EJ, United Kingdom. Registered Charity Number: 1146770 Company Registration Number: 07960219. Title Forename(s). Surname. Address.

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