1. finance
2. bank
3. bank account

Hampshire Cultural Trust
Chilcomb House,
Chilcomb Lane, Winchester,
Hampshire, SO23 8RD
01962 826700
www.hampshireculturaltrust.org.uk
I wish to join the: Founding Ambassador Gold Scheme
Founding Ambassador Scheme
Signed.............................................................................. Date............................
PERSONAL DETAILS
Please note that all information will be treated in the strictest confidence and will not be divulged to any third party.
Title.................................... First name............................................................ Surname..............................................................
Address.........................................................................................................................................................................................
......................................................................................................................................................................................................
..........................................................................................................................Postcode.............................................................
Email.............................................................................................................................................................................................
Telephone................................................................Preferred time and method of contact.......................................................
METHOD OF PAYMENT Please tick box of choice
FOUNDING AMBASSADOR GOLD
FOUNDING AMBASSADOR
£2,500 by cheque p.a.
Please make payable to Hampshire Cultural Trust
£500 by cheque p.a.
Please make payable to Hampshire Cultural Trust
£2,000 by cheque p.a. if paying under
Gift Aid arrangements (note 1)
Please make payable to Hampshire Cultural Trust
£400 by cheque p.a. if paying under
Gift Aid arrangements (note 1)
Please make payable to Hampshire Cultural Trust
£2,500 by standing order with your bank
£625 per quarter, standing order
authorisation form option 1 on reverse
£500 by standing order with your bank
£125 per quarter, standing order
authorisation form option 3 on reverse
£2,000 if paying under Gift Aid arrangements
by standing order with your bank
£500 per quarter (note 1),
standing order authorisation form option 2 on reverse
£400 if paying under Gift Aid arrangements
by standing order with your bank
£100 per quarter,
standing order authorisation form option 4 on reverse
Other method of payment please specify below
.....................................................................................................................................................................................
Other source(s) If you have a company or charitable trust which might contribute, please give very brief details
below and contact Charlotte Smith (details on reverse)
.....................................................................................................................................................................................
Hampshire Cultural Trust, a charitable company
Registered charity number: 1158583
Registered company number: 08986225
Note 1: Gift Aid declaration box on reverse needs to be ticked
STANDING ORDER WITH YOUR BANK
If you elect to have a standing order, we will write to your bank to arrange this.
To the manager (name of bank)...................................................................................................................................................
Address of bank............................................................................................................................................................................
......................................................................................................................................................................................................
Please pay to: NatWest, Old Bank Branch, 105 High Street, Winchester, Hampshire, SO23 9AW
To the credit of: Hampshire Cultural Trust, 55-81-26, 89139925
Option 1:
Option 2:
Option 3:
Option 4:
The sum of £625 per quarter on the................. day of every month
The sum of £500 per quarter on the................. day of every month
The sum of £125 per quarter on the................. day of every month
The sum of £100 per quarter on the................. day of every month
Please debit my account number................................................................... Sort code.............................................................
Name of account holder...............................................................................................................................................................
Signed.............................................................................. Date............................
GIFT AID DECLARATION
Please treat all the qualifying gifts of money made today and in the future as Gift Aid donations
I confirm I have paid or will pay an amount of Income Tax and/or Capital Gains Tax for the current tax year
(6 April to 5 April) that is at least equal to the amount of tax that all the charities that I donate to will reclaim
on my gifts for the current tax year. I understand that other taxes such as VAT and Council Tax do not qualify.
I understand the charity will reclaim 25p of tax on every £1 that I have given.
A DONATION IS WORTH MORE WITH GIFT AID
PLEASE NOTIFY HAMPSHIRE CULTURAL TRUST IF YOU
•
Gift Aid is a simple way for our charity to increase the value of gifts
of money we receive. When a UK taxpayer gives a gift of money to
a charity, tax has already been paid. Therefore this qualifies for
Gift Aid.
•
•
•
•
Because we are exempt from tax, we can claim an amount equal
to the tax paid by a donor on their donation as a repayment from
HM Revenue & Customs (HMRC).
•
Gift Aid allows us to claim back 25p for every £1 you give to us,
boosting the value of your donation by a quarter. All we need
from you is permission to reclaim the tax you have paid.
Want to cancel this declaration
Change your name or home address
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.
We would like to keep you informed about Hampshire Cultural Trust’s future events and exhibitions. If you would prefer not to receive
such communications please tick the box.
Hampshire Cultural Trust complies with the Data Protection Act 1998. Your personal information will be used exclusively for providing you with the
information or service you have requested. We will only send personally identifiable information about you to other organisations when we have
your consent. We will only pass information on in order to provide the information or service you have requested or if we are required to by law.
For any queries please contact Charlotte Smith:
Telephone 01962 826700 or email charlotte.smith@hampshireculturaltrust.org.uk
Please send completed form to:
Charlotte Smith, Hampshire Cultural Trust, Chilcomb House, Chilcomb Lane, Winchester, Hampshire, SO23 8RD