Hospice Sponsorship Form
Name
First Name
Last Name
Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
If I have ticked the box headed 'Gift Aid', I confirm that I am a UK income or Capital Gains taxpayer. I have read the statement and want The Hospice 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 one very £1 that I have given.
Rows
Full Name
Home Address
Amount Pledged
Amount Given
Date Given
Gift Aid
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Submit
Should be Empty: