Individual Options Account: Application

Please complete each of the following sections, Personal Details, On-Line User Details, and Funding Details to open an Individual Options Account.

Fields marked with an asterisk * are required and must be completed to submit the form

Once you have received confirmation that the account has been opened and that on-line access has been activated, donations can be made by eVoucher and regular donations can be made by setting up standing orders on the account at www.charitablegiving.co.uk

If you have any questions, please contact Charitable Giving by telephoning 01822 611180 or via mail@charitablegiving.co.uk.

Personal Details

Title * Initials * Surname * Address Line 1* Address Line 2 Address Line 3 Address Line 4 Postcode * Telephone*

On-Line User Details

Email Address * Password * Confirm Password *

Password must be at least 8 characters long (letters and numbers only) and contain at least one number

Funding Details

Regular funding of at least £10 per month is required. Please complete either or both of the following sections to specify funding through pre-tax (Payroll Giving) and/or post-tax (Bank Standing Order) income

Payroll Giving

I wish to contribute through my employer's Payroll Giving scheme for which the following details are provided:

Employer's Name Employer's Address 1 Employer's Postcode Payroll/NI/Staff No Amount per month £

Bank Standing Order

I wish to contribute by standing order making regular monthly payments to:

Lloyds TSB, Sort Code: 30-98-46, Account No: 01107326, Account Name: Charitable Giving - Collect

and for which details of my bank account and the amount are as follows:

Sort Code: - - A/C Number: Amount per month £

Upon opening your account, you will be provided with a Standing Order reference; your bank sort code and account number will assist us in identifying your contributions

I pay an amount of UK Income and/or Capital Gains tax at least equal to the tax that I would like to be reclaimed on my donations under the Gift Aid scheme by Charitable Giving on my behalf

* I accept Charitable Giving's Terms & Conditions with respect to the operation of my Individual Options Account * I agree that electronic transmission to and receipt by Charitable Giving of the data contained in this form constitutes my authority to affect the instructions herein