SHIVA CHARITY (Schools Helping India Voluntary Association, Regd. no. 1045197)

Please print out and complete

Give As You Earn Individual Joining Form

Employer Contract Number…………………….. Source code: WEB

(to be completed by your payroll)

Please tick if this form is: # First time request

# Additional to existing instructions

# Replacement to existing instructions

NB. If the replacement box is ticked, existing records will be deleted and replaced

Title(Mr/Mrs/Ms/Other) ………… Surname ……………………… Initials …………… …

Home Address ….……………………………………………………………………………..

……………………………………………………………………………………………………

Postcode……………………………………

Employer Name……………………………. Employee Number…………………………

………………………………………………. National Insurance Number……………….

Work Place Address ……………………………………………………………………………

…………………………………………………………………………………………………….

 Direct Donation

Charity name

Donation

Office Use

 

SHIVA charity

19 Daventry Rd, Bristol BS41DQ

£ p

GAYE No

Inputter date

Checker

Tick if you do NOT want your name given to the above charity q Paid Weekly q Paid Monthlyq

qNote: If you wish to keep your choice confidential from your employer, simply tick this box and send this form direct to Give As You Earn, CAF, Kings Hill, West Malling, Kent ME19 4TA

Declaration (This must be completed and signed)Please deduct a total of £___________ from my gross pay each pay day as a gift to charity. I confirm my understanding that no further tax is recoverable on this gift. I 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 any goods or services supplied.

Signature ………………………………………………… Date …………………………

Give As You Earn deducts 4%, with a minimum charge of 25p per deduction to cover its costs.

Donor - Please hand this form directly to your payroll

Payroll - Please keep a copy of this form for your records and send the original form directly to Give As You Earn at this address. Give As You Earn, Charities Aid Foundation, West Malling, Kent, ME19 4TA. If your company does not already operate the scheme please contact us at the same address. Website: www.giveasyouearn.org Email: giveasyouearn@caf.charitynet.org. Charities Aid Foundation, Registered Charity Number 268369