Junction 42 Financial Support Form

YOUR DETAILS
I would like to give to the general funds of Junction 42

Coli
I would like to support _____________________
(staff name) by giving to Junction 42
I would like my gift to go towards (project/purpose) _______________________________
I would like to give __________ to Junction 42. This gift is to be given as a
One-off

Monthly*

Quarterly*

Annual*

donation.

*for gifts to be given monthly/quarterly/annually, please fill in the regular donation section and send back return to
Junction 42.
Name____________________________________________Address_______________________________________________
________________________________________________________________________________________________________
____________________________________________________________________Postcode___________________________
Tel______________________________________________ Email__________________________________________________
Your name will be added to our mailing list, please tick here if you would not like to receive any further updates.

SELF SET-UP (please tick if you have completed self set-up) !

If you would like to set up your giving directly using online/telephone banking, please use the following information:
JUNCTION 42: HSBC PLC

ACCOUNT NO. 11 43 65 38

SORT CODE: 40-46-28

STANDING ORDER FORM (complete if appropriate and we will send this information to your bank)

To the bank manager, ____________________________________________ bank plc

Bank Address_____________________________________________________________________
___________________________________________________Postcode______________________
Please debit from my account the following amount to be paid to Junction 42 (bank details
below)
The sum of ________ on the _____th/rd day of __________________20_____
And monthly/quarterly/annually thereafter from my/our account:
Account No._________________________ Sort Code ___ - ___ - ___
Junction 42:
HSBC Bank, 279 Whitley Road, Whitley Bay, Tyne & Wear, NE26 2SW
Account No. 11 43 65 38

Sort Code: 40-46-28

GIFT AID DECLARATION

Junction 42 is a registered charity and can claim tax relief on gifts from a UK tax payer. To enable us to do this,
please sign the declaration overleaf.

Junction42 Gift Aid Declaration _ for past, present & future donations
Please treat as Gift Aid donations all qualifying gifts of money made
today

in the past 4 years

in the future

Please tick all boxes you wish to apply.

I confirm I have paid or will pay an amount of income Tax and/or Capital Gains Tax for each tax year (6 April to 5
April) 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 Counsel Tax do not quailify.
Your details
Title__________First name or initial(s) __________________________________________________________
Surname ___________________________________________________________________________________
Home address ______________________________________________________________________________
Postcode ____________________________
Date

_______________________________

Signature ____________________________

Please notify the charity if you:

Want to cancel this declaration

Change your name or home address
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
and Customs to adjust your tax code.

Please send this form back to Junction 42,

Venture House, Aykley Heads, Durham, DH1 5TS