Charitable Giving

Example Intranet Donation Choice Form

Please provide the following details if you wish to contribute under the Payroll Giving scheme to any recognised UK charity, church, or charitable organisation.

The minimum total Payroll Giving deduction is £5.00 per month or £10.00 to an Individual Voucher Account

If you wish to specify more than three charities, please complete an additional form.

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

charity and deduction details

Please specify only one type of deduction, either MONTHLY or ONE-OFF, on a form, i e, use a separate form for each type of deduction

For MONTHLY deductions, please tick START for a new deduction, STOP for a deduction to be stopped, or AMEND if an existing deduction is to be increased or decreased. If you are amending a deduction, enter the new amount; if you are replacing one deduction with another, please indicate the name and amount for each charity and indicate STOP for the one and START for the other, as appropriate

For ONE-OFF deductions, please enter the amount(s) only

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

I wish to give my deductions* Monthly One-off donation

select charities
Charity 1	Start	Amend	Stop	Amount £
Charity 2	Start	Amend	Stop	Amount £
Charity 3	Start	Amend	Stop	Amount £
Charity 4	Start	Amend	Stop	Amount £
Charity 5	Start	Amend	Stop	Amount £
Charity 6	Start	Amend	Stop	Amount £
Charity 7	Start	Amend	Stop	Amount £
Charity 8	Start	Amend	Stop	Amount £
Charity 9	Start	Amend	Stop	Amount £

charity 1

Start Amend Stop

Name Amount £ Reg No (If known)

If small/local charity or church, please provide:

Address Line 1 Address Line 2 Address Line 3 Post Code

charity 2

Start Amend Stop

Name Amount £ Reg No (If known)

If small/local charity or church, please provide:

Address Line 1 Address Line 2 Address Line 3 Post Code

individual voucher account

Start Amend Stop

Amount £

PLEASE NOTE: If you are already contributing under the Payroll Giving scheme, no other changes will be made other than those shown above

personal details

Title * Initials * Surname * Payroll/Staff No Address Line 1 Address Line 2 Address Line 3 Postcode * Email Address Telephone

employer details

Name Address Line 1 Address Line 2 Address Line 3 Postcode

preferences

I DO NOT wish the above Personal and Employer details to be passed to any of the above named charities I have no objection to the above Personal and Employer details being passed to any of the above named charities but I DO NOT wish them to be subsequently passed on to other third parties * I understand that my payroll deduction will be dealt with in accordance with the Payroll Giving contract between my employer and Charitable Giving and that no portion of my tax effective payroll giving can be used to make a Gift Aid payment * 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 contained herein

Please add any notes you wish below:

Charitable Giving (Registered Charity No 1128013 Company Registration No 6754603) is an HMRC-Approved Payroll Giving Agency contracted to administer the Payroll Giving scheme of Sample Company ltd. Details of only the total Payroll Giving deduction may be transmitted to an employer’s payroll office and will take effect on the first pay day after receipt. Backdating is not permitted. Details provided on this form are protected by the Data Protection Act.

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Donation Choice Form

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