ARCTIC  RESEARCH  GROUP

Charity No. 1167722

Please print this page and complete the form, then sign it, scan and e-mail it to [email protected]

Title (Please Circle)    Mr / Mrs / Miss / Ms /  Rev. / Dr / Other

Surname……………………………Forename(s)………………………………………

Address……………………………………………………………………………………

……………………………………………………    Postcode………………………….

I want the charity to treat :- (please delete as appropriate)

 All donations I have made for the six years prior to this year, and all donations I make from the date of this declaration until I notify the charity otherwise, as Gift Aid donations

All donations that I make from the date of this declaration until I notify the charity otherwise as Gift Aid donations

You must pay an amount of Income Tax and/or Capital Gains tax at least equal to the tax that the charity reclaims on your donations in the appropriate tax year.

Signature ……………………………………………..    Date ……….………………..