Title: Mr/Mrs/Miss/Ms/Other_______________

Full Name: ____________________________

Address: _____________________________

_____________________________

_____________________________

Post Code: ____________________________

£______________Donation

I confirm that I am a UK taxpayer and I wish The Pied Piper Appeal to reclaim my tax as gift aid.

Signature

_______________________________________

Date:___________________________________

Thank you for your support!

All the data we hold is managed in accordance with The Data Protection Act (1998). We will not disclose any information supplied by you to any third party. We may wish to contact you with information about the charity.

If you do not wish to receive any such information, please tick this box.

Gift Aid is a Government initiative enabling charities to reclaim the tax paid on donations - at no extra cost to you.

If you are a UK taxpayer, using Gift Aid means that The Pied Piper Appeal* gets back an extra 28 pence from the Inland Revenue for every £1 you donate. So long as you pay income tax/capital gains tax at least equal to the amount The Pied Piper Appeal will claim back, you can donate the tax on your gift. Every penny received will help The Pied Piper Appeal make a sick child smile.

*Registered charity number 1011611