Click here to print this page

Close this Page >>

St Andrew’s House
Registered Charity Number 214293

Gift Aid Declaration

Full Name …………………………………………..

Address …………………………………………..

…………………………………………………………..

…………………………………………………………..

Postcode …………………………………………..

Telephone …………………………………………..

I agree to St Andrew’s House reclaiming tax on any donation made by me now or in the future. I note that I should tell St Andrew’s House if I do not pay an amount of tax that at least equals the amount of tax reclaimed by the Home.

Signature …………………………………………..

Date …………………………………………..





Please return this form to the Charity Secretary, St Andrew’s House,
19 St Andrew’s Road, Earlsdon, Coventry CV5 6FP