Banker's Order Form

To the Manager ................................................................................... Bank
Sort Code: ......................................................................................................
Branch Address: .............................................................................................

Pay to: Barclays Bank PLC,
Hatton Garden Business Centre,
99 Hatton Garden,
London EC1N 8DN
(Sort Code 20-37-75)
for the credit of the Cleft Lip and Palate Association (Account number 60588806)

the sum of £..................................................................................... (amount in words)

every month/quarter/year on the same day until further notice (delete as appropriate)

commencing on: .........................................................................................(date)

and debit my account number ............................................................ accordingly

Name: ..................................................................................... (full name in block capitals)

Address: ................................................................................................................. ............................................................................................................................... ...............................................................................................................................

Signed: ................................................................... Dated: ....................................

Under the Gift Aid Scheme, we can claim back the tax on your donation as long as you are a UK taxpayer.
Please fill in this form so we can claim back the tax.

Gift Aid Declaration

Cleft Lip and Palate Association

My Full Name:......................................................................................................
My Address:..........................................................................................................
..............................................................................Postcode:..................................

I want the Cleft Lip and Palate Association to treat the following as Gift Aid donations (delete as appropriate):

  • The enclosed donation of £.........................................................
  • The donation of £........................................... I made on ..../..../....
  • All donations I have made since 6 April 2000, and all donations I make from the date of this declaration until further notice
    Signed:........................................ Date: ..../..../....

please return this form to: CLAPA, 1st Floor Green Man Tower, 332 b Goswell Road, London EC1V 7LQ

Notes:
1. You must pay an amount of income tax and/or capital gains tax at least equal to the tax that the charity reclaims on your donations in the tax year (currently 28p for each £1 you give).
2. You can cancel this declaration at any time by notifying the charity.
3. If in the future your circumstances change and you no longer pay tax on your income and capital gains equal to the tax that the charity reclaims, you can cancel your declaration (see note 1).
4. If you pay tax at the higher rate you can claim further tax relief in your Self-Assessment tax return.
5. If you are unsure whether your donations qualify for Gift Aid tax relief, ask the charity. Or ask you local tax office for leaflet IR 65.
6. Please notify the charity if you change your name or address.