Gift Aid Form.

If donating by cheque or by standing order, please print this form and return it by post:-

The Foundation for Liver Research
The Institute of Hepatology
69 – 75 Chenies Mews, London WC1E 6HX

Please fill in the details below:

Title:

First name:

Surname:

Address:

Postcode:

Day time telephone number:
(Please make sure we can read your full name, home address and postcode)

The Foundation for Liver Research can reclaim the tax back on every donation and get an extra 28% without it costing you a penny more

Please tick here if you are a UK taxpayer and you would like the Foundation for Liver Research to Gift Aid your donation

Please be aware that you must have paid an amount of income tax an/or capital gains tax at least equal to the tax that we claim from your donation in the tax year you make the donation

Thank you for your support

The Foundation for Liver Research c/o The Institute of Hepatology 69 – 75 Chenies Mews, London WC1E 6HX Tel: 020 7679 6510 Fax: 020 7380 0405

Registered charity no. 268211

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