| Donor's Full Name: (in CAPITALS) |
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| Donor's Title: Mr/Mrs/Miss/Ms/Prof |
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| Donor's Address: (in CAPITALS) |
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| Postcode: |
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I want the Society to treat all donations I have made since 6th April 2000 and all donations I make from the date of this Declaration, until I notify you otherwise, as Gift Aid Donations. |
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| Signature of Donor: |
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| Date of Signing: |
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Notes:
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