Yorkshire Charities Group Payroll Giving

Payroll Giving Agreement

Please complete this form on the screen, print off a copy and return it to us at the address below.

I would like to give tax free each pay day £

I already give to charity by payroll deduction, please tick YES NO

(The amount shown above will be added to existing donations unless otherwise indicated)

Title (Mr/Mrs/Ms)

Surname

First Name(s):

Address:

Postcode:

Your telephone number:

Employer's name:

Employer's address:

Employee number:

National Insurance number:

If you prefer that your employer not know which charity you support please tick here:

Declaration (this must be completed and signed)

Please deduct a total of £ from my gross pay each pay day as my gift to the Yorkshire Charities Group. I confirm that my taxed gift to charity through payroll giving will not exceed the statutory limit for each tax year and will not be used as a payment of a covenanted agreement.

Signature......................................................................................

Date..................................................

The Yorkshire Charities Group values your support and promises to respect your privacy. The data we gather and hold is managed in accordance with the Data Protection Act (1998). We will not disclose or share personal information supplied by you, with any third party organisation without your consent.

Once you have completed this form please pass it to your payroll department and send a copy to:

Yorkshire Charities Group, c/o The Financial Accountant, St Anne's Community Services, 6 St Mark's Avenue, Leeds LS2 9BN