SPONSORSHIP AND GIFT AID DECLARATION FORM Harlington Hospice Association, Company Limited by Guarantee No 4199504, Charity No 1099332
We, who have given our names and addresses below, and who have not ticked the box entitled ”No to Gift Aid” ', want the above charity to reclaim tax on the donation detailed below, given on the date shown. We understand that each of us who have not ticked the box entitled “No to Gift Aid” must pay income tax or capital gains tax equal to the tax reclaimed by the charity on the donation.
Full Name	Full Home Address	Post code	Amount  pledged	Amount given	Date given (dd/mm/yy	No to Gift Aid
A)……..…...Gift Aid Total B)……..Non Gift Aid Total A+B)…Total All Donations Harlington Hospice Association, Lansdowne House, St Peters Way, Harlington, Middlesex, UB3 5AB