Step 2 of 3 You are making a regular donation of per year Gift Aid Using Gift Aid means that for every pound you give, we are able to reclaim back from HMRC the tax paid on it - helping your donation to go further. I want to Gift Aid my donation and any donations I make in the future or have made in the past 4 years to Muscular Dystrophy UK from the date of this declaration. You must pay an amount of UK Income Tax and/or Capital Gains Tax for each year (6th April one year to 5th April the next) that is at least equal to the tax that Muscular Dystrophy UK and any other charities and Community Amateur Sports Clubs (CASCs) you support will reclaim on your donations for that tax year . Please note you will be responsible for any shortfall. Muscular Dystrophy UK will claim 25p back for every £1 gift aided. Please let Muscular Dystrophy UK know if you want to cancel this declaration in future, change your name, home address, or no longer pay sufficient tax on your income and/or capital gains. Personal Information Title Mr Mrs Miss Ms Mx Dr Other First name Last name Email Address Phone number Your address House number and street name Address line 2 Town or city Postcode Country United Kingdom Afghanistan Africa Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Antilles Netherlands Argentina Armenia Aruba Asia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean T British Virgin Islands Brunei Darussalam Bulgaria Burkina Faso Burma Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Central America Chad Channel Islands Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote Divoire Crete Croatia Cuba Cyprus Czech Republic Dem Peoples Rep Korea Denmark Djibouti Dominica Dominican Republic East Timor (Timor-Leste) Ecuador Egypt El Salvador England Equatorial Guinea Eritrea Estonia Ethiopia Europe European Union Falkland Islands (Malvinas) Faroe Islands Fed Rep of Yugoslavia Fed States of Micronesia Fiji Finland France French Guiana French Polynesia French Southern Terr Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey and Alderney Guiana French Guinea Guinea Equatorial Guinea-Bissau Guyana Haiti Heard and McDonald Is(AU) Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Ivory Coast Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macao (China) Macedonia TFYR Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique (FR) Mauritania Mauritius Mayotte (FR) Mexico Middle East Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North America Northern Ireland Northern Mariana Islands Norway Oceania Oman Pakistan Palau Palestinian Territory Panama Papua New Guinea Paraguay Peoples Democ Rep Lao Peru Philippines Pitcairn Island Poland Portugal Puerto Rico Qatar Republic of Ireland Republic of Korea (South) Republic of Macedonia Republic of Moldova Republic of Yemen Reunion (FR) Romania Russia Rwanda S Pierre and Miquelon (FR) S Vincent and Grenadines S.George and S.Sandwich Sahara Western Saint Barthelemy (FR) Saint Helena (UK) Saint Kitts and Nevis Saint Lucia Saint Martin (FR) Samoa San Marino Sao Tome and Principe Saudi Arabia Scotland Senegal Serbia Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South America South Korea Spain Sri Lanka St Lucia Sudan Sultanate of Oman Suriname Svalbard and Jan Mayen Is Swaziland Sweden Switzerland Syria Syrian Arab Republic Taiwan Tajikistan Tanzania Thailand The Caribbean Timor-Leste (East Timor) Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Rep of Tanzania Unknown Uruguay US Minor Outlying Isl USA Uzbekistan Vanuatu Vatican Venezuela Viet Nam Virgin Islands British Virgin Islands US Wales Wallis and Futuna West Indies Western Sahara Yemen Zambia Zimbabwe Keep in touch We'd love to keep you updated from time to time about MDUK’s work, opportunities to take part in events and other ways to support. Please keep me involved via email Please keep me involved via SMS Please keep me involved by telephone Please do not contact me by post Stay in control of your details We respect your privacy. We will never share your details for marketing purposes. We will only contact you in the ways that you wish, making use of the information you’ve given us (including your muscle-wasting condition if relevant) and publicly available information. We want to make sure what we communicate with you is relevant to your interests. Our privacy policy is available on our website www.musculardystrophyuk.org/privacy or by phoning 0300 012 0172. About your donation Reason for donation General donation In memory Celebration Comments Tell us the name of the person this donation is in memory of Tell us more about your celebration Payment details Account holder's name* Account number* Please do not include dashes or spaces. Sort code* Six-digit number on your cheque book, bank card or bank statement Direct Debit start date* Payments will be taken on the 6th of the month. August September October November 2024 Frequency Monthly Quarterly Yearly Please specify your preferred collection date. If the collection date selected falls within the next 15 days, the first payment will be collected the following month All payments will appear on your bank statement as Muscular Dystrophy UK. Muscular Dystrophy UK will send you a Direct Debit confirmation email within three working days of submitting your payment. If you are not the named account holder or require another signature to authorise Direct Debits on this account, please download and print a paper Direct Debit form. Direct Debit Service User Number: 808255 I confirm that I am the account holder and I can authorise Direct Debits on this account*