Please use this form to create your new donation. Please be sure to complete all sections so that your donation can be processed as quickly as possible.

How are you paid?

- Select Payment Method - Monthly 4 Weekly Fortnightly Weekly

Select how often you are paid and your donation will be deducted from your pay each day.

Personal Details

Title:	Mr Miss Mrs Ms
Full name:
Home address:
Postcode:
Email:
Telephone:
National Insurance Number:		Please note this is only used by your employer to ensure deductions are made to your pay.

Your Employer's Details

Employer's full name:
Your Workplace address:
Postcode:
Your Employee/Staff number:		This can normally be found on your payslip.

Your Total Donation: £0.00

This is the amount that will be deducted from your GROSS pay and how much your charity will receive.

Cost to you: £0.00

This is how much your donation costs you, i.e. how much you will be donating from your net pay.

Finally, your charity may wish to write to you to say thank you for your donation, if you do not wish them to then please tick here    

The data supplied on this form will be used to enable your donation to reach your chosen charity/ies. In order that your instructions can be acted on, your details will be passed to HM Revenue & Customs registered Payroll Giving Agent, with whom your employer has contracted, who will forward your donation to your chosen charity/ies. HOH will record the details shown on this form for administration purposes.

I confirm that my pre-tax donation through my employers Payroll Giving scheme will not be included in the Gift Aid scheme.