THE NORFOLK RENAL FUND

Charity No. 1045119

Gift Aid Declaration

Your Name (including title)

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Your Address (including postcode)

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This is to request you to treat the enclosed donation
of £ ____ which I make to The Norfolk Renal
Fund as a Gift Aid donation.

I understand that you can only reclaim tax on my donations to the extent that I have actually paid such tax (whether in the form of income tax or capital gains tax).

I understand that I may cancel this Declaration at any time, including retrospectively.

Signature

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Date

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Please use the following details for correspondence or for further information.

Dr A Heaton
Honorary Secretary
The Norfolk Renal Fund
Jack Pryor Renal Unit
Norfolk & Norwich University Hospital
Colney Lane
Norwich
NR4 7UY

Tel: 01603 288248

Fax: 01603 288936