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Mind in Kingston - Donations Form

Please print out, complete and post to Mind in Kingston, Siddeley House, 50 Canbury Park Road, Kingston Upon Thames, Surrey KT2 6LX.

Please make cheques payable to Mind in Kingston. Cheques must be in sterling and drawn on a UK bank.

I would like to make a donation to
Mind in Kingston of £

I would like Mind in Kingston to treat the enclosed donation amount (stated above) as a Gift Aid donation. I confirm that I am a UK tax payer and pay an amount of Income Tax or Capital Gains Tax equal to the tax Mind in Kingston reclaims on my donation.

Yes:

No:

 

Name:

Address:

Postcode:

Telephone:

Email:

Signature:

Date:

Thank you for your kind donation

Mind in Kingston Registered Charity No:1076791