Donation Form

This is a multi-purpose Donation Form designed to be printed out, completed by hand, and ...

1. mailed to us along with your donation

2. mailed to us in order to set up a standing order

N.B. Please mail the completed form to:-
Gwalior Children's Hospital,
14, Magdalene Road,
Walsall,
West Midlands,
WS1 3TA.

Thank you for agreeing to help us by donations to promote our work!

Please complete the appropriate sections below, and if sending a cheques/postal orders/ CAF voucher, please make payable to "Gwalior Children's Hospital".

Donation

* I have pleasure in enclosing a gift of £250 / £120 / £..................or.................. (any convertible currency) to help Children in India.

OR

* Please debit my Switch/ Master/ Visa/ Amex/ Diners Club/CAF card number

        -         -         -        

expiry date 

    

Security code 

  

 (last three digits on back)

Issue date 

    

 

Issue no 

    

 (Switch only)

Name on Card

  

Signature

  

Date

  

Regular Donation (Standing Order)

Bank Address

  

 
   
   

 

  

 

  

Please pay Gwalior Children's Hospital

 

£ .......... or................(any convertible currency)

monthly / quarterly / annually (delete as appropriate)

Starting on .... /.... / 20 .... until further notice.

Please debit my account

Sort Code

    -     -    

A/C Number

               

A/C Name

  

Signature

  

Date

  

** Gift Aid (UK Donors only)

Please treat all my donations from this date and hereafter as gift aid donations. I want the charity to reclaim tax on my donations

About You

Name

  

Address
   
   

Postcode

  

Tel

  

Fax

  

E-mail

  

Donation Usage

* Please use my donation(s) as per the charity needs.
* Please use my donation(s) for..............................................................................................(specify if any preferences for work of your choice).

* Please delete as appropriate. Please fill in the amount, etc., as you wish.

Would you like a receipt? YES / NO

** For donors in U.K. only -- Remember to notify us if you no longer pay an amount of income tax or capital gain tax equal to the tax we reclaim on your donations (28p for every pound you give).If you are a higher rate tax payer, do not forget to claim relief of 18% ( i.e.23p for every pound you give ) in your self assessment return from Inland Revenue.

All donations in U.S.A. with tax benefits are accepted through American fund for charities, a 501 C non profit organisation. Make your cheques in the name of "American Fund for Charities for Gwalior Childrens Hospital" or Contact us for further information.

All Donations in India are exempted for tax under 80G income tax rules. Make your cheques payable to "Gwalior hospital and Education charitable trust" and send it to us.

Donations in any convertible currency can be made.

N.B. Please print and mail the completed form with your donation to:-
Gwalior Children's Hospital,
14, Magdalene Road,
Walsall,
West Midlands,
WS1 3TA.

If sending a cheques/postal orders/ CAF voucher, please make payable to Gwalior Children's Hospital

Thank you