Please tick the following, as applicable:
I would like to become a Friend of St Mary’s, Atherington and enclose a donation / membership fee of £  (minimum £5 please)
I would like to become a Friend of St Mary’s, Atherington and enclose a life membership fee of £50
I would like to help the Tower Appeal and enclose a gift / an interest-free loan (repayable on completion of the project) [click one or the other to delete; click again to reinstate] of £ 

If you are a UK taxpayer and able to ‘Gift Aid’ your giving we can reclaim an extra 22p for every £1 you give us. Please complete this section if you are able. Thank you very much.

[If any of the following options is inapplicable, click the option to delete it; click it again to reinstate it.]
I want the charity to treat

• the enclosed donation(s) of £ as a Gift Aid donation
• the donation(s) of £ which I made on (dd/mm/yyyy) as (a) Gift Aid donation(s)
• all donations that I make from the date of this declaration until I notify you otherwise as Gift Aid donations
• all donations I have made for the six years prior to this year, (from the date of this declaration) and all donations I make from the date of this declaration until I notify you otherwise, as Gift Aid donations

Signed:

Date:

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 appropriate tax year.

Notes:

1. You can cancel this declaration at any time by notifying the charity.
2. 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 your declaration.
3. If you pay tax at the higher rate you can claim further tax relief in your Self Assessment tax return.
4. If you are unsure whether your donations qualify for Gift Aid tax relief, ask the charity, or refer to help sheet IR65 on the HMRC web site (www.hmrc.gov.uk).
5. Please notify the charity if you change your name or address.

When you are satisfied that you have completed the form correctly, please print it by clicking the ‘Print form’ button below, then sign and date it (if you wish us to claim Gift Aid) and post it with your cheque to The Revd. John Carvosso, The Rectory, Tawstock, Barnstaple, EX31 3HZ.