FRIENDS OF KING*S COLLEGE HOSPITAL

Registered Charity No.207328 Give as you earn registration No. 000103887

Donation Form Personal Details * Title _______________ First Name or initial(s) _______________________________________ Surname __________________________________________________ Full Home Address _________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ Postcode ___________________________ * The Friends of King’s College Hospital (The Friends) will hold your personal data in accordance with the Data Protection Act 1998. The Friends do not share your personal data with any other organisation.

Gift Details I enclose a cheque for £25 £50 £100 £250 other £_______________ Please make your cheque payable to ‘The Friends of King’s College Hospital’

Additional Comments Please let us know if there are any special reasons or particular circumstances inspiring your gift _________________________________________________________________________________________ _________________________________________________________________________________________ ……………………………………………………………………………………………………………………………… Make your donation go further! Agree to ‘Gift Aid’ your donation and The Friends will be able to reclaim the tax on your donation. To qualify for Gift Aid you must be a UK taxpayer and 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.

In order to Gift Aid your donation you must tick the box and sign the declaration below. YES, 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. This donation, all donations I have made in the last 4 years and all future donations, unless I notify you otherwise, should be treated as Gift Aid donations.

Signature _______________________________________________________________________ Date ____________________

Many thanks for your support! Please return this form to the address below: The Administrator, Friends of King’s College Hospital, King’s College Hospital, London, SE5 9RS