Sponsorship Form - Pembridge Hospice Charity printable pdf download

Sponsorship Form - Pembridge Hospice Charity

Please make sure you complete these details

Name _______________________________

Address _____________________________

___________________ Postcode_________

Email _______________________________

Phone_______________________________

Sponsorship & Gift Aid Form

Event name _____________________________

<tick = I am happy to be contacted about how my

donation is helping and charity activities

Gift Aid- i

f you are a UK tax payer and tick the gift aid box we can boost the value of your gift by 25p for every £1 given.

If I have ticked the box headed ‘Gift Aid ’, I confirm that I am a UK Income or Capital Gains taxpayer. I have read this statement and

want the charity named above to reclaim tax on the donation detailed below, given on the date shown. I understand that if I pay less

Income Tax / or Capital Gains tax in the current tax year than the amount of Gift Aid claimed on all of my donations it is my

responsibility to pay any difference. I understand the charity will reclaim 25p of tax on every £1 that I have given.

Date

Gift

Title Initial

Surname

Address

(house number & street)

Postcode

Amount

Aid 

Paid

Total

Please send your completed sponsorship form to:

Fundraising, Pembridge Hospice Charity, St Charles

Date given to charity

Hospital, Exmoor Street, London, W10 6DZ.

Thank you for supporting our patients

Sponsorship Form - Pembridge Hospice Charity