Section 1: Your details *

First Name

Last Name

Section 2: Your Gift

I am giving a one off lump sum

on

MM

DD

YYYY

OR

I will give in instalments

weekly

monthly

every 3 weeks

other (please specify)

This will start on

MM

DD

YYYY

and the last payment will be on

MM

DD

YYYY

Section 3: Gift Aid

Gift Aid allows St Nic’s to claim an extra 25p for every £1 donated by eligible tax payers.

I am a UK taxpayer and wish St Nic's to claim back the tax paid on my gift by gift aid

I cannot gift aid

Section 4: Gift will be made by

Direct Bank transfer*

Cheque**

Charity voucher

Cash