Greenwich & Bexley Cottage Hospice

Payroll Giving Form

Please print and complete this form, and return it to the Freepost address below.  

Title (Mr/Mrs/Ms/Miss)     ________________________________

Surname                       ________________________________

First Name(s)                 ________________________________

Your address                  ________________________________

                                   ________________________________

Postcode                       ________________________________

Country                         ________________________________

Email address                  ________________________________

Work telephone               ________________________________

Employer's Name              ________________________________

Employee's Work Number   ________________________________

National Insurance Number  _______________________________  

Please let us know your intentions or wishes by ticking the appropriate boxes. 

I am planning to set up a payroll-giving donation with my company and you should be receiving my donations shortly 1

Monthly1   Weekly1

£5 1£10 1£25 1or other amount £ 1

My company does not have a payroll giving scheme; please contact me to discuss the possibility of setting one up. 1

Signed    _______________________ Date_________________________

Please return form to:   Greenwich & Bexley Cottage Hospice

                                Fundraising Department

                                FREEPOST LON 15994

                                      London

                                SE2 0BR

                                Tel:020-8312 2244

                                      THANK YOU