Jim Jones 43 Long Lane, Bedford 25.00

pon or hip form

FUNDRAISER’S DETAILS Name of event:

Date of event:

Name of participant:

Date donations sent to charity:

Address: Postcode:

For Office Use Only

Email: Tel (Day):

Mobile:

Make every £1 you donate worth an extra 25p – at no extra cost to you. * If I have ticked the box headed Gift Aid, I confirm that I am a UK Income or Capital Gains tax payer. I have read this statement and want Children with Cancer UK to reclaim tax on the donation detailed below, given on the date shown. I understand that if I pay less income tax than the amount of Gift Aid being claimed on all my donations to charities in the current tax year, it is my responsibility to pay any difference. I understand the charity will reclaim 25p of tax on every £1 I have given. For further information about Gift Aid visit: www.childrenwithcancer.org.uk/gift-aid

First Name

Jim

Last Name

Jones

To Gift Aid your donation, please follow these simple steps: 1. Write your full name below 2. Write the first line of your home address AND your FULL postcode 3. Tick the Gift Aid box to confirm we are allowed to claim! 4. Fill in the amount paid and the date paid

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43 Long Lane, Bedford

MK40 3FS

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(Only needed if you are Gift Aiding your donation)

Amount

Date paid

01/06/2012

Tick to Gift Aid*

NAME EVENT Children with Cancer UK is the leading national children’s charity dedicated to the fight against childhood cancer. We fund life-saving research into the causes, prevention and treatment of childhood cancer and we work to protect young lives through essential welfare programmes. First Name

Jim

Last Name

Jones

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43 Long Lane, Bedford

MK40 3FS

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(Only needed if you are Gift Aiding your donation)

Amount

TOTAL DONATIONS RECEIVED Please feel free to photocopy this form

Please send completed form and funds raised to: Children with Cancer UK, 51 Great Ormond Street, London WC1N 3JQ Please make cheques payable to Children with Cancer UK. Children with Cancer UK is a company limited by guarantee. Registered Charity No. 298405. Registered in England No. 4960054.

T 020 7404 0808

E [email protected]

W childrenwithcancer.org.uk

Date paid

01/06/2012

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Tick to Gift Aid*