Name *

First Name

Last Name

What type of donation did you just make? *

One-off donation

Monthly donation

This donation is my own money. It has not come from anyone else e.g. a business, friends, family or a collection.

Agree

Disagree

This donation is not the proceeds from the sale of goods or provision of services e.g. a cake sale, auction or car wash.

Agree

Disagree

I am not receiving any benefits from this donation e.g. entry to an event, raffle or sweepstakes. I want to Gift Aid my donation and any donations I make in the future to Robin Hood Health Foundation. I am a UK taxpayer and understand that if I pay less Income Tax and/or Capital Gains Tax than the amount of Gift Aid claimed on all my donations in that tax year it is my responsibility to pay any difference. Please notify the charity if you want to cancel this declaration, change your name or home address, or no longer pay sufficient tax on your income and/or capital gains. If you pay Income Tax at the higher or additional rate 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.

Agree

Disagree

Would you like to add gift aid?

Yes, add gift aid

No, do not add gift aid

Date

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DD

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