Registered charity no: 1075743

MY DETAILS

Name: _________________________________________________ Address: _________________________________________________ _________________________________________________ Postcode: _____________ Phone no: ___________________________

Email: _________________________________________________

GIFT AID DECLARATION

If you want your donation to go further, Gift Aid it. For every pound you give to us, we get an extra 28 pence from the Inland Revenue. Just make sure that your details above have been fully completed.

I want all donations I have made since 6 April 2007 and all donations in the future to be Gift Aid until I notify you otherwise. (Please tick the box and make sure we have your name and full address above)

To qualify for Gift Aid, what you pay in income tax or capital gains tax must at least equal the amount we will claim in the tax year.

STANDING ORDER MANDATE

(Please return this to the Trust at the address given below, not your Bank, with, if relevant, the Gift Aid declaration box ticked above)

Account name: ___________________________ Sort Code: ___- ___-___ Account no: _______________ Bank address: _________________________________________________________________ Please pay to: National Westminster Bank plc (60-13-57) 22 Broad Street, Lyme Regis, DT7 3QG for the credit of the Lyme Regis Development Trust (A/c No: 83733280) Amount £ _______ (in figures) ______________________________ (in words)

on _________________________ and thereafter on the same day each year

until further notice * / or until ___________ * (delete as appropriate)

Please debit my above account: NAME (Block capitals) ___________________________________________

SIGNATURE ___________________________________

DONATION

I enclose a donation of £10, £25, £50 or £ ____ * (delete as appropriate) towards the work of the Lyme Regis Development Trust.

(Please make your cheque payable to Lyme Regis Development Trust and send it with this form to the address at the bottom of this sheet. If appropriate, please tick the Gift Aid box above.