Gift Aid declaration form

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Surname

Address *

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Telephone

I confirm that I am a UK taxpayer. I pay an amount of income tax or capital gains tax at least equal to the tax that the British Lung Foundation will reclaim on my donations. I would like the British Lung Foundation to treat all donations I have made since 6 April 2000, and all donations I make from the date of this declaration until I notify you otherwise, as Gift Aid donations. *

Date (dd/mm/yyyy) *

• Please contact us if you change your name or address

• Please contact is if your status changes, for instance, if you no longer pay tax that is at least equal to the tax which the British Lung Foundation will reclaim

• Your declaration can be cancelled at any time by notifying the British Lung Foundation, 73-75 Goswell Road, London, EC1V 7ER. (Registered charity no of England and Wales. 326730), Charity reg in Scotland- SC038415

Under the terms of the Data Protection Act, the British Lung Foundation and its related company, BLF Trading Ltd, will retain and use the data you have provided for administrative purposes and to inform you of its fundraising and other activities. We hope you will want to remain in touch with our work, but if you would prefer not to receive future mailings, please tick this box

The British Lung Foundation may supply information to other charitable organisations for their use in seeking support. If you would prefer that we do not supply your details to other such organisations, please tick this box