Gift Aid Donation Form

I want to Gift Aid my donation and any donations I make in the future, or have made in the past four years, to the London School of Hygiene & Tropical Medicine.

I am a UK taxpayer and understand that if I pay less Income Tax and/or Capital Gains Tax in the current tax year than the amount of Gift Aid claimed on all my donations, it is my responsibility to pay any difference. London School of Hygiene & Tropical Medicine will claim 25p on every £1 donated.

Title:

First Name:

Surname:

Email:

Telephone Number:

Home Address Line 1:

Home Address Line 2:

Home Address Line 3:

Town/City:

Postcode:

Today's Date:

Please notify the London School of Hygiene & Tropical Medicine 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 Self Assessment tax return or ask HM Revenue and Customs to adjust your tax code.