Prostate Cancer UK

Prostate Cancer UK Donation Form

How it works

Simply by completing this form, you can support
Prostate Cancer UK 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  
Cost to you as a 20% taxpayer  
Cost to you as a 40% taxpayer  
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 :
Charity Name :
Charity Name :
+ More Charities
Charity Name :
Charity Name :
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 payslip)
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 . We (Payroll Giving in Action) receive a fee from our member charities based on results. Read our Solicitation Statement here.
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.
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.
I would like to receive updates and communications from my chosen charity(ies) about how my support is being used, or about special projects, events or appeals via:-
Please tick here if you wish your name to be given to any other charitable organisations whose mission the above charities feel may be of interest to you.
By not selecting this you may still be contacted only in the event of a specific query needed to resolve the processing of your data for the purposes of these instructions.
Please tick here if you wish us to keep you up to date by email/SMS with all things Payroll Giving.
Form security information
Your IP address:
Time/date stamp: 30 Nov 2015 04:19:45
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.