PAYROLL GIVING DONATION FORM

Sane Donation Form

How it works

Simply by completing this form, you can support
Sane from your pay.

Pay no tax

Because the donation is taken from your gross pay, every pound you give
will only cost you 80p, or only 60p if you are a higher rate tax payer.

You donate	£5.00	£7.50	£10.00
Cost to you as a 20% taxpayer	£4.00	£6.00	£8.00
Cost to you as a 40% taxpayer	£3.00	£4.50	£6.00

Source code: PGA [Agency: ]

Please select donation type
This is a first time donation
This donation supersedes any previous donation given
Add this donation to my existing donations

I would like to give tax-free from my pay to:	Monthly Amount	4 Weekly Amount	Fortnightly Amount	Weekly Amount
	£ . p	£ . p	£ . p	£ . p
	£ . p	£ . p	£ . p	£ . p
	£ . p	£ . p	£ . p	£ . p

Enter total amount to be deducted each pay day: £ . p

DECLARATION: By signing this form you are confirming your understanding that no further tax is recoverable on this gift and understand that only gifts to organisations with charitable status within the UK can be accepted and that no gift can be made as a membership subscription or to pay for goods or services supplied.
Title:
First name:
Last name:
Email address:
Confirm e-mail address:
Telephone number:
Mobile number:

Your home address
Address line 1:
Address line 2:
Town / city:
County:
Postcode:

Your employment details

Employer's name (in full):

Work address line 1:

Work address line 2:

Work town / city:

Work county:

Postcode:

Employee/staff number:

Normally found on payslip. We cannot identify your gifts without it.

NI number:

Your digital signature
Enter your full name as confirmation of the completed form:
Please tick here if you are interested in employee volunteering or staff fundraising for charity
No part of your donation is taken by us in commission. We are paid a fee from the charity based on results.
Please Note: You should allow up to 6 weeks before the donation will show on your pay slip. The time delay depends on when your payroll department receives the form relative to the cut-off date for each payroll run.

Data protection
The data supplied on this form will be used to enable your donations to reach your chosen charity/ies. In order that your instructions can be acted on, your details will be passed to Her Majesty's Revenue & Customs registered agency, with whom your employer is contracted, who will forward your donation to your chosen charity/ies. Your chosen charity/ies may send you a thank you letter acknowledging your donation.
Please tick here if you do not wish to receive updates and communications from your chosen charity about how your support is being used, or about special projects, events or appeals.
Please tick here if you do not wish your name to be given to any other charitable organisations whose mission the above charities feel may be of interest to you.

Form security information
Security code: (enter code on right)
Your IP address:	38.107.191.81
Time/date stamp:	3 Sep 2010 16:53:57
SSL encryption:	This page is protected with a Geotrust SSL with up to 256-bit encryption. Your confidential information cannot be viewed, intercepted or altered.