GWALIOR CHILDRENS HOSPITAL ORPHANAGE APPEAL

Yes I want to help.

Enclosed is my donation of £10/ £50/ £120 or other ......... in my preferred currency of ....................

AND/OR

I promise to pay Gwalior Children's Hospital the sum of £.............each year / each month from.........until further notice.
Please debit my account (account number)................................... Bank branch sort code........................Bank/Building Society address.................................................... ..................................................................... ..................................................................... ...........................

OR

Please debit my Switch /Master / Visa / Amex / Diners Club / CAF Card
Card No............... .......... .......... .........Expiry Date......../........ Issue No (Switch only).........
Title........ Full Name...................................................... Address.................................... ..................................................................... ...............Post Code.................................. Telephone number......................... email: ......................................

GIFT AID:

I would like the Gwalior Children's Hospital to reclaim the tax on this donation. I am a UK tax payer. [All donations in UK, USA and India are exempted for tax as per rules of the country.]

Signature....................................................................Date..............................................


Slip should be returned with cheque (if required) to:
Gwalior Children's Hospital Charity 14 Magdalene Road, Walsall, West Midlands WS1 3TA, UNITED KINGDOM