Norwich Theatre Royal Charitable Pledge Agreement Please complete this form and return in the freepost envelop to Norwich Theatre Royal. We will acknowledge this with a receipt for your records and tax purposes if you Gift Aid your donation. Name __________________________________________________________________________ Address ____________________________________________ ____________________________ ____________________________________________________ Postcode ____________________ Telephone _______________________________________________________________________ Email address ____________________________________________________________________ I hereby agree to pay the sum stated below to Norwich Theatre Royal’s fundraising campaign. I agree to make the following contribution as: A single sum payment of £ ________________________________on date ________________ Or Monthly instalments of £___________ for _______months, starting on __ / __ / __ (For instalments please complete Direct Debit mandate below) Acknowledgement We would like to ensure that we comply with your wishes as well as fundraising best practice and data protection. Would you be happy for us to acknowledge your donation? (Please delete) •
Internally with Norwich Theatre Royal Board and Staff
YES
NO
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Publicly on Norwich Theatre Royal Donor Boards
YES
NO
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Publicly on Norwich Theatre Royal publicity material
YES
NO
Norwich Theatre Royal, charity number 262259 is registered under HMRC’s Gift Aid Scheme. Using Gift Aid means that for every pound you give, Norwich Theatre Royal will receive an extra 25% from the HMRC, helping your donation go further. Imagine what a difference that could make and it doesn’t cost you an extra penny.
Gift Aid Declaration I want to Gift Aid my donation of……………………………..and any donation I make in the future or have made in the past 4 years to Norwich Theatre Royal. I am a UK taxpayer and understand that if I pay less Income Tax or Capital Gains Tax then the amount of Gift Aid claimed on all my donations in that tax year it is my responsibility to pay any difference. Please notify Norwich Theatre Royal 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. If you pay Income Tax at the higher or additional rate and want to receive the additional tax relief due to you, you must include all your Gift Aid donations on your SelfAssessment tax return or ask HM Revenue and Customs to adjust your tax code. Signatre………………………………………………………………..
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