Gift Aid Scheme - Written Declaration

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To: Cumbria Amenity Trust Mining History Society

I, (full name)*

Of (Address line 1):*

Address line 2:

Address line 3:

County:

Postcode:*

I wish the Gift Aid Scheme to apply to all subscriptions and/or donation payments I have made since 1st April 2000, and to all such payments I may make thereafter.

I understand that for this Declaration to be valid I must be paying to the Inland Revenue, or have tax deducted from my income, an amount of income tax or capital gains tax at least equal to the amount of tax reclaimable by the Trust in respect of my subscription/donation payments. (Also that, if appropriate, I can claim Higher Rate Tax Relief for my personal benefit via my tax-return.

I will notify the Society if I cease to pay tax as above, and also understand that I can cancel, in writing, this Declaration at any time.

Please reclaim tax accordingly.

Signed (FULL NAME):*

Date:*

This form does not require witnessing.

It is for an unlimited period, covering all payments until cancelled.

No National Insurance Number or Tax Reference is required.

Please notify the Charity if you change your name or address.

Registered Charity No 519424.