Foundation

GIFT AID DECLARATION

Details of donor

Title……….Forename(s)………………………………………Surname………..………………………

Address………………………………………………………………………………………………………………………………………………………………………………………………………………………………Postcode…………………..

This declaration confirms my wish that any donation I make to The Romilly Forshall Foundation after 6^th April 2000 is to be treated as a gift under the Gift Aid Scheme. I confirm that I am a UK taxpayer, and that I am resident in the United Kingdom for tax purposes.

Date…../……/………. Signed……………………………..

Thank you. If you’d also like to make a regular gift, please fill in the banker’s order form below and return it to: The Romilly Forshall Foundation, 40 Acton Lane, London, W4 5ED.

Please pay The Romilly Forshall Foundation the sum of £………

monthly/quarterly/twice yearly/annually (*Delete as appropriate)

starting on : Day……………Month……..Year………………

until further notice/ until (and including) the year………. (*Delete as appropriate)

PAYABLE to: The Co-operative Bank, PO Box 101, 1 Balloon Street, Manchester M60 4EP (08-92-99), to the credit of The Romilly Forshall Foundation a/c 65051175

Sort code……………….(6 figures) Account No……………………..……..(8 figures)

To (name and address of bank)………………………………………………………….

…………………………………………………………………………………………………

……………………………………………….

Postcode………………….

Signature………………………………………Date………………………….

FOR BANK USE ONLY: Please quote reference: ………………………………….

Please send this form to The Romilly Forshall Foundation, 40 Acton Lane, London, W4 5ED, NOT your bank. Thank you very much for your kind gift.

The Romilly Forshall Foundation is a registered charity (No.1082605)

40 Acton Lane, London W4 5ED. ' 020 8994 8544

www.romilly.org email: thedraketeam@aol.com

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