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Donation Form


Thank you for choosing to make a donation to Crossroads Care. Please print and complete this form and return it with your donation to Crossroads Care Brentwood Basildon & Districts, 14-16 The Broadway Wickford Essex SS11 7AA.  Remember that we can benefit even more from your donations if you are a tax payer and complete the Gift Aid Declaration section of this form.

 
Your Name & Address

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.................................................................................     Telephone No.....................

 Type of Donation (please tick the appropriate box(es))

[  ]  I/We wish to sponsor ____ Care Hours annually at 20 per hour and enclose a cheque for ______

[  ]  I/We wish to become a member of Crossroads Care Brentwood Basildon & Districts and enclose a cheque for ____   as my/our subscription for the     current year (minimum 10 per person or 25 for Corporate membership)

[  ]  I/We wish to make a regular donation to Crossroads Care. Please send me the appropriate banking details.

Please send me a receipt  [  ]       more information [  ]

 

Signed: ____________________        Date:   ______________

 

Please make cheques payable to:- Brentwood & District Crossroads.
 

 Gift Aid Declaration


Crossroads Care Brentwood Basildon and Districts

Please treat as Gift Aid donations all qualifying gifts of money made

 today [  ]  in the past 4 years [  ]  in the future [  ]

Please tick all boxes you wish to apply.

I confirm I have paid or will pay an amount of Income Tax and/or Capital Gains Tax for each tax year (6 April to 5 April) that is at least equal to the amount of tax that all the charities that I donate to will reclaim on my gifts for that tax year. I understand that other taxes such as VAT and Council Tax do not qualify. I understand the charity will reclaim 28p of tax on every 1 that I gave up to 5 April 2008 and will reclaim 25p of tax on every 1 that I give on or after 6 April 2008.

Donor’s details

Title ……….. First Name ………………………………. Last Name ……………………………………

Full Home Address: ………………………………………………………………………………………………..

……………………………………………………………………………Postcode: …………………………………

Date: ………….…………………

Signature: ………………………………………………

 

Please notify us if you:

  • Want to cancel this declaration
  • Change your name or home address
  • No longer pay sufficient tax on your income and/or capital gains tax.


If you pay Income tax at the higher or additional rate you and want to receive the additional tax relief due to you, you must include all your Gift Aid donations on your Self Assessment tax return or ask HM Revenue and Customs to adjust your tax code.

 

Charity Registration No. 1054595 A company limited by guarantee registered in England No. 3172543