CYMDEITHAS TREFTADAETH DYFFRYN CONWY

CONWY VALLEY CIVIC SOCIETY

Registered Charity Number 509030

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GIFT AID DECLARATION

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Donor:

Title: _______Forename(s) ________________   Surname ____________________

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Full Home Address ______________________________________

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                                 _______________________________________

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                                 _______________________________________

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Post Code ___________________

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I want Cymdeithas Treftadaeth Dyffryn Conwy/Conwy Valley Civic Society to treat all donations I have made in the last 4 years and all donations I make from the date of this declaration, until I notify you otherwise, as Gift Aid Donations.

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I am a UK taxpayer and understand that if I pay less Income Tax and/or Capital Gains Tax than the amount of Gift Aid claimed on all my donations in that tax year it is my responsibility to pay any difference.

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Signed _______________________                  Date. ____________________

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Please notify us if you:

* want to cancel this declaration

* change your name or home address

* no longer pay sufficient tax on your income and/or capital gains