Making a Regular Gift

I would like to make a donation of £ ............... per month/quarter/half year/ each year* and enclose a completed Deed of Covenant and/or payment authority* * Please delete as appropriate

Charity Registration Number. 1057894 Charity No 3005-0T Deed of Covenant To Association of Wheelchair Children Notes I promise to pay you for .... years, or during my 1 lifetime, if shorter, a sum such as after deduction of income tax at basic rate amounts to £ ........................................... 2 each (month)(quarterly)(year) 3 from (the date shown below) 4 Signed and delivered ........................ 5 Date ............................................ 5 Full Name ....................................... Address.......................................... .......................................... .......................................... Witnessed by .................................... Signed .......................................... 5 Full Name ....................................... Address ......................................... ......................................... ......................................... Notes 1. Enter the period of the covenant, minimum 4 years 2. Enter the amount you will be paying the charity 3. Delete as appropriate to show how often you will make the payment 4. Delete as appropriate. If you choose to enter the actual date it must not be earlier than the date you sign the deed. 5. You must sign the form and enter the date you actually sign it in the presence of the witness, who should also sign where shown.