Name:

Full Postal Address:

Postcode:

Email Address:

Phone:

Today's Date:

My Donation (Please state amount/month, and day of the month due, or one-off donation):

Declaration: Yes, I would like NOTDEC UK to treat all donations I make to them as Gift Aid donations until I notify them otherwise. 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 also give permission for the charity to claim gift aid on any donations I have made to them during the last four years. 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.