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: