Donation Form
I want to make a difference
To make a donation, please complete this form in BLOCK CAPITALS and return to:
Advancement Office, Trinity House, De Montfort University, The Gateway, Leicester, LE1 9BH.
1. Your details
Full name and address
Daytime telephone
Evening telephone
Email address
2. Gift details
I/we would like to make a single/regular gift (please delete as appropriate) toward:
 The Vice-Chancellor’s Fund
 The Gunn and Carter Fellowship
 The Student Enhancement Fund
I/we would like to donate by:
 Cash
 Cheque
 Credit/Debit Card
 Diabetes Research
 Direct Debit (Complete section 4)
3. Single gift
I/we would like to make a gift of £ ________
I/we wish to make my/our gift by:
I/we enclose
 MasterCard
 Cash
 A cheque made payable to De Montfort University
 Visa
 Visa Delta
 Maestro/Switch
Name on card
Cardholder’s Address
Credit/Debit card number
Maestro/Switch issue number
Security code (last 3 numbers on signature strip)
Expiry date
Signed
Date
Valid from date
4. Regular gift
I/we would like to make a monthly/quarterly/annual gift (please delete as appropriate) of £ ______ Commencing on ___ /___ /______ for ___ years
(Amount will be debited from your account on or around 15th of the month)
To the Manager of Bank/Building Society Name
Bank/Building Society Address
Name of account holder
Account Number
Sort Code
Signed
Date
Instruction to your bank building society.
Please pay De Montfort University direct debits from the account detailed in this instruction subject to the safeguards assured by the Direct Debit Guarantee. I
understand that this instruction may remain with De Montfort University and, if so details will be passed electronically to my bank/building society.
5.Gift Aid declaration
Making your gift go further
DMU can claim Gift Aid tax relief of 25p on every £1 donated, provided that you paid an amount of UK tax equal to the amount we reclaim. This
means that every £20 gift is worth £25 to the university at no extra cost to the donor.
If you pay tax at the higher rate, you can claim tax relief on your Self Assessment tax return.
I/we wish DMU to treat this donation, all donations I have made in the last 4 years and all donations I may make from the date of this declaration
until I notify you otherwise, as Gift Aid donations.
Signed
Date