Lottery Membership Application

Thesumof(tickoneboxonly)

The sum of (tick one box only)

1 Number

£4.34 Monthly ❑

£13.00 Quarterly ❑

£26.00 Half Yearly ❑

£52.00 Annually ❑

2 Numbers

£8.68 Monthly ❑

£26.00 Quarterly ❑

£52.00 Half Yearly ❑

£104.00 Annually ❑

NB: Monthly subscription first payment is £5 per number

Official Use Only

Payments to be paid on either 6th, 13th, 20th or 27th of each month

First payment due immediately and thereafter on 6th or 20th of each month.

Please fill in the form and send to: DAAT Lottery, 5 Sandpiper Court, Harrington Lane, Exeter EX4 8NS. Name and full postal address of your bank or building society

Date

•Allcustomerfundsintendedfortheuseinfuturegamblingandorlotterysubscriptionswillbeheldinaseparatebank account or accounts relating to the relevant affiliated charity lottery and will be completely separate from the Charity’s trading income.

•Wearerequiredbyourlicencetoinformcustomersaboutwhathappenstofundswhichweholdonaccountforyou,and the extent to which funds are protected in the event of insolvency. www.gamblingcommission.gov.uk/consumers/protection-of-customer-funds.aspxWeholdcustomerfundsseparatefrom Charity’s funds. This means that steps have been taken to protect customer funds but that there is no absolute guarantee thatallfundswillberepaid.ThismeetstheGamblingCommission’srequirementsforthesegregationofcustomerfunds at the level: medium protection.

•Thelicenseeoperatesastrictno‘cashpolicy’topreventtheriskofcrimessuchasmoneylaundering,toavoidthegiving of illicit credit and to provide assurances that gambling activities are being conducted fairly.

Banks and building societies may not accept Direct Debit Instructions for some types of account. By signing this form you agree to the lottery terms and conditions. For a copy of the terms and conditions please call 01392 469886.

This Guarantee should be retained by the payer.

The Direct Debit Guarantee

• This Guarantee is offered by all banks and building societies that accept instructions to pay Direct Debits.

This Guarantee is offered by all banks and building societies that accept instructions to pay Direct Debits Ifthereareanychangestotheamount,dateorfrequencyofyourDirectDebitPSLre DAAT Lottery will notify you 5 working days in advance of your account being debited orasotherwiseagreed.IfyourequestThePSLreDAATLotterytocollectapayment, confirmationoftheamountanddatewillbegiventoyouatthetimeoftherequest

• If there are any changes to the amount, date or frequency of your Direct Debit DAAT Lottery will notify you five (5) working days in advance of your account being debited or as otherwise agreed. If you request DAAT Lottery to collect a payment, confirmation of the amount and date will be given to you at the time of the request.

If an error is made in the payment of your Direct Debit, by PSL re DAAT Lottery or your bank or building society, you are entitled to a full and immediate refund of the amount paid from your bank or building society

• If an error is made in the payment of your Direct Debit, by DAAT Lottery or your bank or building society, you are entitled to a full and immediate refund of the amount paid from your bank or building society.

– If you receive a refund you are not entitled to, you must pay it back when PSL re DAAT Lottery asks you to.

- If you receive a refund you are not entitled to, you must pay it back when DAAT Lottery asks you to.

• You can cancel a Direct Debit at any time by simply contacting your bank or building Society. Written confirmation may be required. Please also notify us.

You can cancel a Direct Debit at any time by simply contacting your bank or building society.Writtenconfirmationmayberequired.Pleasealsonotifyus.

DAA would like to keep you informed about our work, how your support has helped to keep our helicopters in the air and how you can be involved in the future. We take the protection of your personal information very seriously and don’t share your data with any third party. If you would like to receive our Helipad magazine or occasional information about our charity please tick the relevant boxes below: Please contact me by email ¨ Please contact me by post ¨

Please contact me by telephone ¨ Please contact me by SMS message ¨

To read our Privacy Statement: Visit www.daat.org/gdpr-statement or, to request a copy, email: fundraising@daat.org or ring 01392 466666

We would like to use winners name and general location for our weekly results on our website/poster. Please tick here if you are happy for us to use this information ¨