PLEASE PRINT FORM

This form is for individual supporters. If you are completing a standing order on behalf of a company or social group,

please contact our Fundraising Department on 020-8319 9230 or Email: appeals@gbch.org.uk for an alternative form.

Please print out, complete, sign and return to : Finance Department,

Greenwich & Bexley Cottage Hospice, 185 Bostall Hill, Abbey Wood, London , SE2 0GB.  

To: The Manager………………………………………………………………………………………Bank plc

(Address)………………………………………………………………………………………………  Postcode………………….

Please pay Greenwich & Bexley Cottage Hospice via

NatWest Bank, 1 Townley Road, Bexleyheath, Kent , DA6 7JG .

Account Number 39014940 Bank Code 51-70-14  

Please R one box below

5 £5     5£10     5£15     5£20     5 other £……

per month/quarter/year – please delete as applicable

Starting Date ..……………     Account No……………………………… Sort Code ……………

Surname……………………………….Title: Mr/Mrs/Miss/Ms First Name ………..................

Address…………………………………………………………………..…… Postcode…………………

Tel No………………………………………… Email address ……………………………

Gift Aid Declaration

If you are a UK taxpayer we can, through the Government's Gift Aid scheme, reclaim the tax on any donations you make allowing us to

increase the value of each donation by 28p for every pound you give.

Please R if Greenwich & Bexley Cottage Hospice can reclaim tax on your donations 5

“I would like Greenwich & Bexley Cottage Hospice to claim back the tax on all donations over the past 6 years and all donations I make

from the date of this declaration as Gift Aid until I notify you otherwise. I understand that I must pay an amount of income tax and/or

capital gains tax at least equal to the tax that the charity reclaims on my donations in the tax year (currently 28p for each £1 you give)”

Signature……………………………………………………………   Date………………………

Our Reference Number …………………………………………………………. (FOR OFFICE USE ONLY)