Gift Aid Declaration "*" indicates required fields Your details... Title* Mr Mrs Miss Ms Dr First name* Surname* Email* Mobile number* Your address... Please enter your postcode and select your address* Address line 1* Address line 2 Address line 3 City / Town* County Postcode* Country*AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsBilling State***Please select a state**ALAKASAZARCACOCTDEDCFMFLGAGUHIIDILINIAKSKYLAMEMHMDMAMIMNMSMOMTNENVNHNJNMNYNCNDMPOHOKORPWPAPRRISCSDTNTXUTVTVIVAWAWVWIWYI wish to Gift Aid my donation and increase its worth by 25% at no cost to me... I am a UK tax payer and confirm I will pay an amount of UK income tax or Capital Gains tax for each year that is at least equal to the amount of Gift Aid that all charities that I donate to will reclaim on my behalf. I understand that if I pay less Income Tax/Capital Gains Tax in any tax year than the amount claimed on my donations, it will be my responsibility to pay any difference back.GA Declaration* Yes claim Gift Aid for the last four years /and any I may make in the future, until I notify you otherwise Yes claim Gift Aid for my latest donation /and any I may make in the future, until I notify you otherwise I am NOT a UK taxpayer or do not wish to Gift Aid my donations Find out the difference your support makes... Thank you for supporting The Myton Hospices so we can continue to provide our services free of charge to people, and their families, living with terminal illnesses. We may keep in touch with you by post and phone to tell you more about our vital work and other ways you can help, including opportunities to donate, fundraise or volunteer and how your support has made a difference. Please let us know if you’re also happy to hear from us by email and text: By email* Yes No By text* Yes No Your privacy... We promise to do our best to keep your details safe and secure and will only process your data in accordance with the current Data Protection legislation. Our Privacy Policy explains how we keep this promise and you can read more online at www.mytonhospice.org/privacy-policy If you change your mind about hearing from us please email DSCT@mytonhospice.org or call us on 01926 358383. I have read and accept The Myton Hospices Privacy Policy* I accept