| I would like The Norfolk and Norwich Association for the Blind to treat: | |
 The enclosed donation of £__________ |
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| The donation(s) of £__________ which I made on _____/_____/_____ |
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| All donations I make from the date of this declaration until I notify you otherwise |
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| as Gift Aid donations. (please tick box) |
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| I confirm that I am a UK taxpayer and that the amount of tax I pay exceeds the amount I would like the Association to claim. | |
| Signature ______________________________ Date ______________ | |
| Name: (in block capitals please) | ___________________________________ |
| Address: | ___________________________________ |
| Postcode: | ___________________________________ |
| Please send me further information about: | |
| Setting up a standing order donation |
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| Leaving a legacy to The Norfolk and Norwich Association for the Blind |
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| Thank you for your help. | |
| Registered Charity No: 207060 | |