Alzheimer's Research Trust

I WOULD LIKE TO GIVE TAX FREE FROM MY PAY TO:

THE ALZHEIMER'S RESEARCH TRUST

£ per week

£ per month

I already give to charity by payroll deduction. Yes No (please tick)
this will be ADDED to existing donations unless otherwise stated.

Title Mr/Mrs/Ms
Initials
Surname
Address
Address 2
Postcode

Employer's Name
Employee No.
National Insurance No.
Workplace address
Address 2
Postcode

Declaration (This must be completed and signed)

Please deduct a total of £ from my gross pay each pay day as a gift to charity. I confirm that my total gifts to charity through Payroll Giving will not exceed the statutory limit in any tax year and will not be used in payment of a covenanted agreement. I understand that only gifts to organisations with charitable status within the UK can be accepted and that no gifts can be made as a membership subscription or to pay for goods or services supplied.

Signature Date