Forename Surname

HOME Address (House name/number and post code are

required for Gift Aid) Amount pledged

Amount given

Date given (dd/mm/yy)

Gift Aid? (!) House Number/name

Home Post Code

Joe Example 17 CA1 2BC £5.00 £5.00 27.07.06 !

Please don’t give us your work address – it means we will not be able to claim Gift Aid on your donation

Sub Total carried forward £

GIFT AID – If you are a UK Taxpayer we are able to recover the tax paid on your donations, at no extra cost to you. If you would like to gift aid your donation please tick the “Gift Aid” box on the form below. We can claim Gift Aid tax relief of 25p on every pound you give. Please note that you should have paid sufficient income tax or capital gains tax (not including Council Tax or VAT) equal to or greater than the amount to be reclaimed and you must provide your house number and post code.

The person shown is raising funds for Eden Valley Hospice and Jigsaw Cumbria’s Children’s Hospice to help us sustain the specialist care we provide for people with life limiting /terminal conditions. Please support their efforts on our behalf with sponsorship.

Forename: Surname:

Sunday 13th May 2018

Raising funds for

Eden Valley Hospice and

Jigsaw Children's Hospice

Gift Aid - If I have ticked the box headed ‘Gift Aid? √’, I confirm that I am a UK Income or Capital Gains taxpayer. I have read this statement and want the charity or Community Amateur Sports Club (CASC) named above to reclaim tax on the donation detailed below, given on the date shown. I understand that if I pay less Income Tax / or Capital Gains tax in the current tax year than the amount of Gift Aid claimed on all of my donations it is my responsibility to pay any difference. I understand the charity will reclaim 25p of tax on every £1 that I have given.

Forename Surname

HOME Address (House name/number and post code are

required for Gift Aid)

Amount pledged

Amount given

Date given (dd/mm/yy)

Gift Aid? (!)

House Number/name Home Post Code

Joe Example 17 CA1 2BC £5.00 £5.00 27.07.06 !

Please don’t give us your work address – it means we will not be able to claim Gift Aid on your donation

Sub Total carried forward £

Freepost RTLY-KCCK-SZKX, Eden Valley Hospice, Carlisle CA2, 4SD (No stamp required)

Please complete your name & address details here. From ________________________________________ Address__________________________________________________________________________________ _______________________________Post Code______________ Telephone __________________________ Email Address _____________________________________________________________

Thank you for your support, we will send an official thank you in due course.  Eden Valley Hospice – A Registered charity No 1008796  

Once you have collected all your sponsorship/donations please forward them in the form of a cheque payable to “Eden Valley Hospice” together with your completed sponsorship forms to:

Colour Run Sponsor form continued

Forename Surname

HOME Address (House name/number and post code are

required for Gift Aid)

Amount pledged

Amount given

Date given (dd/mm/yy)

Gift Aid? (!)

House Number/name Home Post Code

Joe Example 17 CA1 2BC £5.00 £5.00 27.07.06 !

Please don’t give us your work address – it means we will not be able to claim Gift Aid on your donation

Sub Total carried forward £

Freepost RTLY-KCCK-SZKX, Eden Valley Hospice, Carlisle CA2, 4SD (No stamp required)

Please complete your name & address details here. From ________________________________________ Address__________________________________________________________________________________ _______________________________Post Code______________ Telephone __________________________ Email Address _____________________________________________________________

Thank you for your support, we will send an official thank you in due course.  Eden Valley Hospice – A Registered charity No 1008796  

Once you have collected all your sponsorship/donations please forward them in the form of a cheque payable to “Eden Valley Hospice” together with your completed sponsorship forms to:

Colour Run Sponsor form continued

Forename Surname

HOME Address (House name/number and post code are

required for Gift Aid)

Amount pledged

Amount given

Date given (dd/mm/yy)

Gift Aid? (!)

House Number/name Home Post Code

Joe Example 17 CA1 2BC £5.00 £5.00 27.07.06 !

Please don’t give us your work address – it means we will not be able to claim Gift Aid on your donation

Sub Total carried forward £

Freepost RTLY-KCCK-SZKX, Eden Valley Hospice, Carlisle CA2, 4SD (No stamp required)

Please complete your name & address details here. From ________________________________________ Address__________________________________________________________________________________ _______________________________Post Code______________ Telephone __________________________ Email Address _____________________________________________________________

Thank you for your support, we will send an official thank you in due course.  Eden Valley Hospice – A Registered charity No 1008796  

Once you have collected all your sponsorship/donations please forward them in the form of a cheque payable to “Eden Valley Hospice” together with your completed sponsorship forms to:

Colour Run Sponsor form continued

Forename Surname

HOME Address (House name/number and post code are

required for Gift Aid)

Amount pledged

Amount given

Date given (dd/mm/yy)

Gift Aid? (!)

House Number/name Home Post Code

Joe Example 17 CA1 2BC £5.00 £5.00 27.07.06 !

Please don’t give us your work address – it means we will not be able to claim Gift Aid on your donation

Sub Total carried forward £

Freepost RTLY-KCCK-SZKX, Eden Valley Hospice, Carlisle CA2, 4SD (No stamp required)

Please complete your name & address details here. From ________________________________________ Address__________________________________________________________________________________ _______________________________Post Code______________ Telephone __________________________ Email Address _____________________________________________________________

Thank you for your support, we will send an official thank you in due course.  Eden Valley Hospice – A Registered charity No 1008796  

Once you have collected all your sponsorship/donations please forward them in the form of a cheque payable to “Eden Valley Hospice” together with your completed sponsorship forms to:

Colour Run Sponsor form continued

Forename Surname

HOME Address (House name/number and post code are

required for Gift Aid)

Amount pledged

Amount given

Date given (dd/mm/yy)

Gift Aid? (!)

House Number/name Home Post Code

Joe Example 17 CA1 2BC £5.00 £5.00 27.07.06 !

Please don’t give us your work address – it means we will not be able to claim Gift Aid on your donation

Sub Total carried forward £

Freepost RTLY-KCCK-SZKX, Eden Valley Hospice, Carlisle CA2, 4SD (No stamp required)

Please complete your name & address details here. From ________________________________________ Address__________________________________________________________________________________ _______________________________Post Code______________ Telephone __________________________ Email Address _____________________________________________________________

Thank you for your support, we will send an official thank you in due course.  Eden Valley Hospice – A Registered charity No 1008796  

Once you have collected all your sponsorship/donations please forward them in the form of a cheque payable to “Eden Valley Hospice” together with your completed sponsorship forms to:

Colour Run Sponsor form continued

Forename Surname

HOME Address (House name/number and post code are

required for Gift Aid)

Amount pledged

Amount given

Date given (dd/mm/yy)

Gift Aid? (!)

House Number/name Home Post Code

Joe Example 17 CA1 2BC £5.00 £5.00 27.07.06 !

Please don’t give us your work address – it means we will not be able to claim Gift Aid on your donation

Sub Total carried forward £

Freepost RTLY-KCCK-SZKX, Eden Valley Hospice, Carlisle CA2, 4SD (No stamp required)

Please complete your name & address details here. From ________________________________________ Address__________________________________________________________________________________ _______________________________Post Code______________ Telephone __________________________ Email Address _____________________________________________________________

Thank you for your support, we will send an official thank you in due course.  Eden Valley Hospice – A Registered charity No 1008796  

Once you have collected all your sponsorship/donations please forward them in the form of a cheque payable to “Eden Valley Hospice” together with your completed sponsorship forms to:

Colour Run Sponsor form continued

Name:

Please complete your name and address details here:

Once you have collected all your sponsorship/donations you can:• Donate online at www.edenvalleyhospice.org• Call the Fundraising Team on 01228 817613 and donate via credit/debit card• Send a cheque made payable to ‘Eden Valley Hospice’ to the address below• Drop off your money at the hospice on Durdar Road, Carlisle or into any of the hospice shopsPlease return your sponsorship forms to the address below:

Freepost RTLY-KCCK-SZKX, Eden Valley Hospice, Durdar Road, Carlisle, CA2 4SD

Forename Surname

HOME Address (House name/number and post code are

required for Gift Aid)

Amount pledged

Amount given

Date given (dd/mm/yy)

Gift Aid? (!)

House Number/name Home Post Code

Joe Example 17 CA1 2BC £5.00 £5.00 27.07.06 !

Please don’t give us your work address – it means we will not be able to claim Gift Aid on your donation

Sub Total carried forward £

Freepost RTLY-KCCK-SZKX, Eden Valley Hospice, Carlisle CA2, 4SD (No stamp required)

Please complete your name & address details here. From ________________________________________ Address__________________________________________________________________________________ _______________________________Post Code______________ Telephone __________________________ Email Address _____________________________________________________________

Thank you for your support, we will send an official thank you in due course.  Eden Valley Hospice – A Registered charity No 1008796  

Once you have collected all your sponsorship/donations please forward them in the form of a cheque payable to “Eden Valley Hospice” together with your completed sponsorship forms to:

Colour Run Sponsor form continued