Friend Application Form – Fill Out and Use This PDF

© The People’s Dispensary for Sick Animals 03/12

BEST FRIENDS DIRECT DEBIT – WEB FORM

Thank you for choosing to become a PDSA Best Friend. All you need to do, to make your regular monthly payment of at least £3, is complete the details below and return this form to:

PDSA, Freepost, Telford, Shropshire TF2 9YQ.

Title: Mrs/Mr/Ms/Miss/Mr & Mrs/Dr/other

First name

Surname

Address

County

Postcode

Date of birth

Tel.

Email

q Please tick if happy to receive information from PDSA via telephone. q Please tick if happy to receive information from PDSA via email.

Protecting your personal data

PDSA and its subsidiary companies process your personal data in PDSA’s database. We may use this information to contact you by post, telephone or email about our work, and to raise vital funds using appeals, competitions, trading offers, PDSA-branded financial services, volunteering opportunities or sponsored events. We may also use this information for planning or administration purposes. Please write to us, or phone 0800 019 9166 to tell us your preferred contact details.

Occasionally, we allow carefully selected organisations to contact our supporters directly. If you would prefer PDSA not to transfer information about you, then please tick this box. q

I wish to start a monthly Direct Debit of £3 or £					per month to become a PDSA Best Friend
starting on		(please make this date at least one month from today).
Name and full postal address of your Bank or Building Society
Name of Account holder(s)
Bank/Building Society account no. qqqqqqqq						Sort code qq–qq–qq

Instructions to your Bank or Building Society to pay by Direct Debit – Originator’s ID no. 970773. Please pay PDSA Direct Debits from the account detailed in this instruction subject to the safeguards assured by the Direct Debit Guarantee. I understand that this instruction may remain with PDSA and, if so, details will be passed electronically to my Bank/Building Society.

Signature(s)		Date

If you DO NOT wish to receive your copy of COMPANIONS every quarter, please tick this box. q

If you DO NOT wish to receive your PDSA Welcome Pack, please tick this box. q

Make your gift go even further. We can claim back the basic rate of tax on any eligible donations received from UK taxpayers – all you have to do is sign and date the form below. Every £1 you give us will be worth £1.25. Please tick one of the boxes below.

qYes, I am a UK taxpayer and I want PDSA to treat as Gift Aid donations all qualifying gifts of money made in the past four years and all donations I make from the date of this declaration until I notify you otherwise

qNo, I am not a UK taxpayer (this will save us writing to you again about Gift Aid).

Date				Signature
Title				First name or initial(s)
Surname						Full home address

Postcode

•I confirm that I have paid, or will pay, an amount of Income Tax and/or Capital Gains Tax for each year (6 April one year to 5 April the next) that is at least equal to the amount of tax that all the charities that I donate to will reclaim on my gifts for that tax year.

•I understand that other taxes such as VAT and Council Tax do not qualify for Gift Aid.

•I understand the charity will reclaim 28p of tax on every £1 that I gave up to 5 April 2008 and will reclaim 25p of tax on every £1 that I give on or after 6 April 2008.

Please notify PDSA if you; want to cancel this declaration; change your name or home address; or no longer pay sufficient tax on your income and/or capital gains.

If you pay Income Tax at the higher or additional rate and want to receive the additional tax relief due to you, you must include all your Gift Aid donations on your Self Assessment tax return or ask HM Revenue & Customs to adjust your tax code.

Thank you

Reference 108915

This guarantee should be detached and retained by the payee.

The Direct Debit Guarantee

•This Guarantee is offered by all banks and building societies that accept instructions to pay Direct Debits.

•If there are any changes to the amount, date or frequency of your Direct Debit PDSA will notify you 10 working days in advance of your account being debited or as otherwise agreed. If you request PDSA to collect a payment, confirmation of the amount and date will be given to you at the time of the request.

•If an error is made in the payment of your Direct Debit, by PDSA or your bank or building society, you are entitled to a full and immediate refund of the amount paid from your bank or building society.

•If you receive a refund you are not entitled to, you must pay it back when PDSA asks you to.

•You can cancel a Direct Debit at any time by simply contacting your bank or building society. Written confirmation may be required. Please also notify us.