I WANT TO ASSIST ICA’s DEVELOPMENT WORK
YOUR GIFT WILL HELP US INCREASE THE DONATION BY 25%
Please print out and fill in section 1 and the relevant section(s) of this form and send the whole form to ICA:
1. DECLARATION
TITLE (MISS/MR/MRS) :
DONORS SURNAME:
DONORS FORENAMES:
DONORS ADDRESS:
POST CODE:
I am an UK taxpayer intending tax to be reclaimed on this donation.
Signature___________________________ Date____________________________________
It helps us considerably if you pay your Gift Aid Donation by standing order.
N.B. This declaration permits us to reclaim 25p for every £1 you give and on any other subsequent donations. If however your tax status changes and the amount we are reclaiming is more than the amount of income tax or capital gains you are paying please let us know.
2. DONATION
I wish to make a one-off donation to ICA and enclose £___________________________
I wish to make a regular donation to ICA and have filled in the standing order form below.
I wish to cancel my declaration and am notifying (in writing/orally) ICA accordingly.
3. STANDING ORDER
To (Name of bank & branch name)_______________________________________________
(Bank address)______________________________________________________________
Full name on account__________________________________________________________
Bank Sort Code_________________ Account No___________________________________
Please pay the sum of £_____________ monthly/quarterly/annually (delete as appropriate) starting on (date)____________ to International Comunity Assist at Church View, Putney, Devizes, Wiltshire, SN10 3RD. Girobank Account No. 57444189 Sort Code 72 00 03
Signature______________________________
4. OTHER INFORMATION I would like information on:
| Families Together | I/we would like to be linked to an Albanian Family for £120 each year |
| Business Together | I/we would like to support a micro-finance project for £300 a year. |
| Schools Together | I/we would like our school/organisation to be linked to an Albanian School. |
| Student’s Together | I/we would like information on supporting an Albanian Student in the UK. |
| E Mail Information | I would like to receive information via E Mail.* |
* My e-mail address is ____________________@________________________