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GBP - Pound Sterling
EUR - Euro
USD - U.S. Dollar
AUD - Australian Dollar
CAD - Canadian Dollar
CHF - Swiss Franc
CZK - Czech Koruna
DKK - Danish Krone
HKD - Hong Kong Dollar
HUF - Hungarian Forint
ILS - Israeli New Sheqel
JPY - Japanese Yen
MXN - Mexican Peso
NOK - Norwegian Krone
NZD - New Zealand Dollar
PHP - Philippine Peso
PLN - Polish Zloty
RUB - Russian Ruble
SEK - Swedish Krona
SGD - Singapore Dollar
THB - Thai Baht
TWD - Taiwan New Dollar
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Please read and confirm the following statements.
This donation is my own money. It has not come from anyone else e.g. a business, friends, family or a collection.
This donation is not the proceeds from the sale of goods or provision of services e.g. a cake sale, auction or car wash.
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 Priscilla Bacon Hospice Charity. 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.
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