OLD PHAROSIANS' ASSOCIATION
MEMBERSHIP FORM
Section A - to be completed by all members
Name: ……………………………………………………………. Years at school: …………………..
Address: …………………………………………………………………………………………………
……………………………………. Post Code: …………………… Home phone: ………………….
Email address: .....................................................
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Section B - to be completed by all members
BANKER'S ORDER
To: The Manager ………………………………………….. Bank Plc (name of member's bank)
………………………………………………………………… (address of member's bank)
Account number: …………………………………………. Date: …………………………
Please pay on 1st August next to Lloyds TSB Bank Plc (sort code 30-93-34) Market Square, Dover, Kent for the credit of the Old Pharosians' Association, account 1991864 the sum of £5.00 (five pounds only) and continue this amount annually, on the same date, without application, from my account identified above.
Signature: …………………………………….
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Section C - to be completed by members who are UK taxpayers and who wish to provide additional benefit to the Association under "Gift Aid".
GIFT AID DECLARATION
Full name: ……………………………………………. Title: ………………………………………….
Address : ………………………………………………………………………………………………...
…………………………………………. Post code: …………………………
I confirm that I am a UK taxpayer and want the Old Pharosians' Association to claim back the tax on the donation of £5 I made on ………/………/………, and all donations I make after the date of this declaration, under the Gift Aid measures.
I confirm that I will be paying income tax or capital gains tax of more than the tax the Association will reclaim on my donation (28p for every £1 donated).
Signature: ……………………………………
Date: …………………………………………
Please return the whole form to the Membership Secretary, Old Pharosians' Association,
Little Rock, 6 Park Road, Temple Ewell, Near Dover, Kent, England. CT16 3AJ.