APPLICATION TO JOIN HELP FOR NEPAL

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Welcome to Help for Nepal. This is a UK Registered Charity (Charity Number: 1186858) committed to provide positive impact in peoples lives in Nepal. Your support and contribution will help this Charity to achieve its objective(s). Let's work together.

Title *

First Name or Initial (s) *

Surname or Last Name *

Full Home Address: *

Please enter full home address

Post Code *

Please enter your home Post Code

Telephone Number: *

E-mail Address *

Charity Gift Aid Declaration - multiple donation. I would like to join Help for Nepal and would like to make Git Aid Declaration. Gift Aid declaration will boost your donation by 25p of Gift Aid for every £1 you donate.

In order to Gift Aid your donation you must tick the box below: *

I want to Gift Aid my initial donation as stated below and any donations I make in the future or have made in the past 4 years to.

Other:

Required

Gift Aid is reclaimed by the charity from the tax you pay for the current tax year. Your address is needed to identify you as a current UK taxpayer.

I would like to donate the following amount as my initial contribution (one off payment) while joining: *

Please enter amount in Pound Sterling (GBP £ ) No upper or lower limit. This is a voluntary contribution while joining. Enter £0.00 if you do not want to contribute this time.

I would like to donate the following amount by regular monthly Bank Standing Order or Direct Debit: *

Please enter amount in Pound Sterling (GBP £5.00 or above (minimum £5)).

Donor Declaration (Please Tick) *

I am a UK taxpayer and understand that if I pay less Income Tax and/or Capital Gains Tax than the amount of Gift Aid claimed on all my donations in that tax year it is my responsibility to pay any difference.

Required

Please notify the charity if you:

1. want to cancel this declaration
2. change your name or home address
3. no longer pay sufficient tax on your income and/or capital gains.

If you pay Income Tax at the higher or additional rate and want to receive the additional tax relief due to you, you must include all your Gift Aid donations on your Self-Assessment tax return or ask HM Revenue and Customs to adjust your tax code.

Full name of individual declaring that you have signed this form electronically. *

Form completed on *

YYYY

IMPORTANT Point: Please make a payment and start standing order as declared above into the Charity Bank account before submitting this form. Charity Bank: HSBC, Account Name: Help for Nepal, Sort Code: 40-35-34, Account Number: 24093313. Please type your name on the payment Reference field.

Membership Type *

Membership Number (OFFICE USE ONLY)

(Help for Nepal representative can enter membership number if issuing in person)

Remarks / Note(s) if any

Could you please let us know who introduced you with this Charity and encouraged to submit this form please?

Thank you very much for joining the Help for Nepal. Help for Nepal team will validate your form and will contact you where necessary. Once confirmed we will arrange to send welcome letter with Membership Number at our earliest convenience.

HELP FOR NEPAL TEAM

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