Pembrokeshire U3A – Gift Aid Declaration

Member Details

Title

Forename 1

Surname 1

Forename 2

Surname 2

Amount Paid
—Please choose an option—£10£15£20£25

Address

House Name/No

Street

Village

Town

County

Post Code

Gift Aid Declaration

I confirm I have paid or will pay an amount of income tax and/or Capital Gains tax for the tax year
(6th April to 5th April) that is at least equal to the amount of tax that all the charities or
Community Amateur Sports Clubs that I donate to will reclaim on my gifts for that tax year.

I wish to Gift Aid my membership payment

Signatures

Person 1 Full Name or Signature

Person 2 Full Name or Signature (if both claiming)

Date