DONATION FORM
I would like to help Age UK London by making a donation
Your details:
Title:
Mr
Mrs
Miss
Ms
Dr
Other
First name: ____________________________________________________________
Surname:
____________________________________________________________
Address:
____________________________________________________________
____________________________________________Postcode: __________________
Telephone: __________________________________Email:_____________________
Your bank details:
Bank name:
_______________________________________________________
Bank address:
Postcode:
_______________________________________________________
_______________________________________________________
Name of account holder: _________________________________________________
Sort code:
______________________________________________________
Account number: ______________________________________________________
Amount to be paid: ______________________________________________________
Starting on:
This donation is
signed:
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One off
monthly
quarterly
annual
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Gift aid: Use gift aid and you can make your donation worth more.
For every pound you donate Age UK London can claim back 28p for every £1 that you
donate from the government – at no extra cost to you. If you are a UK taxpayer and
would like to help us in this way then please complete this next section of the form:
Tick this box if you are a UK taxpayer
Dr/Mr/Mrs/Miss/Ms/Other __________ Your name: _____________________________
Signed:
Thank you for your support
Please return this form to:
Age UK London, Freepost, LON 7615, SE1 6BR
Office use only:
Ref number : ________________ (to be quoted by payee’s bank)
Payable to: Arbuthnot Latham, Arbuthnot House, 20 Ropemaker Street, EC2Y 9AR
Account number: 11631701 Sort Code: 30-13-93
Data protection: Any information you have provided to Age UK London will not be
shared with any third party.
Please tick if you would like Age UK London to email you any further information that may be
of interest