Bank/ Cash Collection

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Bank/ Cash Collection

Please fill out this form if the donation is made by cash or bank transfer

Payment Method

Name

First

Last

Date amount Donation

Phone

Address

Address Line 1

City

State / Province / Region

Postal Code

Country

Donation amount

Donation Date

Reclaim Gift Aid

Yes, I am a UK tax payer and would like Gift Aid claimed on my donations
No, I am not a UK tax payer and do not want Gift Aid claimed on my donations

I confirm that I am a UK taxpayer. I understand that if I pay less Income Tax or Capital Gains Tax than the amount of Gift Aid claimed on my donations in the tax year I will pay the difference. I agree to Gift Aid this donation and any future donations. Tell Crisis Aid if you want to cancel this declaration, change your name or home address, or if you stop paying enough tax.