Please print and fill in this Gift Aid Declaration Form and send this to us with your donation.

​

                                                     Gift Aid Declaration

                                                            The H. J. Eysenck Memorial Fund


            Date: ......../......../........



            Details of donor:


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


            Home Address ......................................................................................................................


                                    ......................................................................................................................


                                    .......................................................................... Post Code ..........................



            I want the charity to treat the donation of: £ .....................

​

                                                  which I made on: ......../......../........ as a Gift Aid donation.

​

            Notes:

            * You must pay an amount of Income Tax and/or Capital Gains Tax at least equal to the tax the charity

               reclaims on your donations in the tax year.


            * You can cancel this declaration at any time by notifying the charity.


            * If you pay tax at the higher rate you can claim further relief in your Self Assessment Tax Return.​​​​​

​