Alzheimer’s Society
    Gift Aid Declaration Form

    Boost your donation by 25p of Gift Aid for every £1 you donate at no extra cost to you!
    There is absolutely no obligation to make further donations but should you decide to do so we will be able to claim Gift Aid on these donations as well.
    By completing the form below you are agreeing to sign up to the Gift Aid Scheme.

     Title _________ Initial* _________ First Name____________________________________

    Surname* _______________________ House No/Name*____________________________


    Postcode* _____________________ Date* ______________
    * These details are required to make a valid Gift Aid claim

    Amount of recent donation: £___________________

    Yes, I am happy for all gifts of money that I have made to Alzheimer's Society in the past 4 years and all future gifts of money that Imake to be Gift Aid donations. Alzheimer’s Society will reclaim 25p of tax on
    every £1 I give.
    I am a UK taxpayer and understand that if I pay less Income Tax & Capital Gains Tax in the current tax year than the amount of Gift Aid claimed on all of my donations across all Charities, it is my responsibility to
    pay any difference.
    Gift Aid is reclaimed by Alzheimer’s Society from the tax I pay for the current tax year.

    Signature _______________________________________________

     Please Note:
     You can cancel this declarationat any time by notifying Alzheimer’s Society.
     If in the future your circumstances change and you no longer pay tax on your income and capital gains
    equal to the tax that all charities reclaim, you can cancel your declaration.
     If you pay tax at the higher rate you can claim further tax relief in your Self-Assessment tax return.
     If you are unsure whether your donations qualify for Gift Aid tax relief, please ask us, or refer to the help
    sheet IR65 on the HMRC web site -
     Please notify us immediately if you change your name or address.