If you pay Income Tax, it would also help us if you complete this form.
It would enable us to claim back your income tax on this donation.

Gift Aid Declaration  Registered Charity No 288347

Name of Charity              Cirencester Open Air Swimming Pool

Details of donor

Title ……Forename(s) …………………………………… Surname …………………

Home address …………………………………………………………………………………

……………………………………………………………………………………

………………………………………………… Post Code ……………………

I want the charity to treat* the enclosed donation of £ ……………… as a Gift Aid donation.

*I confirm that I have paid Income Tax (and/or Capital Gains Tax) equal to or greater than
the tax that the charity reclaims on my donation, in this tax year.

Signed…………………………………                                     Date………………………