CLIC Sargent

CLIC Sargent Donation Form

How it works

Simply by completing this form, you can support
CLIC Sargent 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 60p if you are a higher rate tax payer.

You donate  
Cost to you as a 20% tax payer  
Cost to you as a 40% tax payer  
Cost to you as a 45% tax payer  
Payroll Giving Logo
Source code: PGA [Agency: ]
 Please select donation type
 How often are you paid?
Please select your payment frequency :
 Which tax band are you in?
Please select your tax band :

Click here to read the Tax Band explanation

I would like to give a regular tax-free donation from my pay to:
Charity Name :
Total amount to be deducted from your Gross pay each pay day: £ 0.00
Cost to you from your Net take home pay: £ 
Total amount your chosen charity(ies) will receive : £ 
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.
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:
Your employment details
Employer's full name :
Employee/staff number: (Normally found on pay slip)
National Insurance Number:
Workplace Postcode:
Work address line 1:
Work address line 2:
Work town / city:
Work county:
Your digital signature
Enter your full name as confirmation of the completed form:
No part of your donation is taken by us in commission .
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. In some instances a small transaction fee may be deducted by your employers chosen Payroll Giving Agency.
Data protection
Opting in to receive charity marketing communications means you can see how your chosen charity/ies use your donations to help provide their services. “Marketing” consists of any communication which promotes a charity or its values, so could be anything from a newsletter to a specific appeal.

Without you, we can’t fight tirelessly for young lives against cancer. We want to let you know about the difference you make to young cancer patients and their families, and other opportunities you have to get involved with fundraising, volunteering and our campaigns. If you would like to opt in to receive this information from the following channels, please tick
Your details are safe with us. For more information about how CLIC Sargent use your information, please read our privacy policy.

You can update your preferences at any time by calling us on 0300 330 0803, emailing or searching ‘CLIC Sargent keeping in touch’
Form security information
Your IP address:
Time/date stamp: 21 Sep 2018 13:45:31
SSL encryption: GeotrustThis page is protected with a Geotrust SSL with up to 256-bit encryption. Your confidential information cannot be viewed, intercepted or altered.

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If you are having difficulty with this form email or call 01271 344360.

Payroll Giving in Action - Millennium House, Brannam Crescent, Barnstaple, Devon EX31 3TD