Details of donor:

Title_____ Forename _______________ Surname ______________________

Address:

____________________________________________ Post code: _________

I want Plant a Tree in Africa (PATIA) to treat ........

- the enclosed donation of £______________

- the donation(s) of £__________ which I made on ___________

- all donations I have made since 6th April 2000, and all donations I
make from the date of this declaration, until I notify you otherwise

.......as Gift Aid donations

Signed____________________________ Date_________

NOTES:
1. You can cancel this declaration at any time by notifying PATIA in writing
2. You must pay an amount of income tax and/or capital gains tax at least equal to the tax that the
charity reclaims on your donations in the tax year (currently 28p for each £1 you give).
3. If in the future your circumstances change and you no longer pay tax on your income and/or
capital gains tax equal to that the Charity reclaims, you can cancel your declaration (see note 1)
4. If you pay tax at the higher rate you can claim further tax relief for yourself in your
Self Assessment tax return
5. Please notify PATIA if you change your name or address


Please return this form to:

PLANT A TREE IN AFRICA, 48 CHURCHWARD AVENUE, SWINDON SN2 1NH