Gift Form

For one-off gifts to AMEN, please print out this form, fill in the details, and send it to

AMEN, 79 North Road, Dartford,   Kent   DA1 3ND   United Kingdom

I/We enclose a donation of      £ ......................... to AMEN

Name(s)                ...................................................................

Address               ..................................................................................................................................

                           ................................................................... Post Code      ......................................

Telephone No.      .............................................   Fax No.   ...........................................................

E Mail Address     ....................................................................

If you live outside UK, in order that we do not incur extra charges, please use a Bankers Draft in

Sterling drawn on a UK Bank.

IMPORTANT NOTE

If you are a UK Tax Payer, please would you please consider completing the following

 Gift Aid Form so that you gift can be increased by a refund to us of the basic tax

which you have paid. This costs you nothing but benefits AMEN greatly

Gift Aid Declaration

Title:                    .................. ( Mr, Mrs, Miss, Rev, Dr, etc.) 

Forename(s)        ....................................................    Surname:  ........................................................

Declaration:   I wish AMEN to treat all donations I have made since 6th April 2000 and all donations 

I make from the date of this declaration until I notify you otherwise as Gift Aid Donations

Signature              ....................................................  Date   ............................................

Please read the following notes:

1   You can cancel the declaration at any time by notifying us - it will not apply to donations you

     make on or after the date of cancellation or such later date as you specify

2   You must pay an amount of income tax and/or capital gains tax at least equal to the tax that

     we reclaim on your donations in the tax year

3   If you pay tax at the higher rate you can claim further tax relief in your Self Assessment tax return

4   If you are unsure whether your donations qualify for Gift Aid tax relief, ask your local tax office

     and/or obtain the Inland Revenue leaflet about Gift Aid (IR113)

AMEN will be holding the personal contact information you have provided to enable us to be able to keep you informed of what the charity is doing. It will not be circulated to any other organisations or charities without your specific written permission

AMEN is a Registered Charity  No: 1057626