Hywel Dda Health Charities Guidance to staff on managing fundraising activities Policy Number: Supercedes: Standards For Healthcare Services No/s Version No: Date Of Review: Reviewer Name: Completed Action: Approved by: Date Approved: New Review Date: Brief Summary of Document: To outline the key principles and practices that govern our approach to the management of all fundraising activity for Hywel Dda Health Charities to ensure that the charity and our fundraisers work in a way that complies with good practice. To be read in conjunction with: 1. Hywel Dda Health Charities Policy & User Guide 2. Charitable Funds Administration & Governance Financial Procedure Classification: Corporate Category: Policy Freedom Of Information Status Open Authorised by: Sarah Jennings Job Title Director of Strategic Partnerships Signature:
Responsible Officer/Author: Contact Details: Nicola Llewelyn Dept Strategic Partnerships Job Title: Base Fundraising Officer Hafan Derwen Tel No 01825 4815 E-mail: nicola.llewelyn@wales.nhs.uk Scope ORGANISATION WIDE DIRECTORATE DEPARTMENT ONLY COUNTY ONLY Staff Group Administrative/ Estates Medical & Dental Nursing Allied Health Professionals Ancillary Maintenance Scientific & Professional Other Please indicate the name of the individual(s)/group(s) or committee(s) involved in the consultation process and state date agreement obtained. CONSULTATION Individual(s) Group(s) Date(s) Date(s) Committee(s) Charitable Funds Committee Date(s) 16/09/2014 RATIFYING AUTHORITY (in accordance with the Schedule of Delegation) NAME OF COMMITTEE A = Approval Required FR = Final Ratification KEY Date Approval Obtained COMMENTS/ POINTS TO NOTE Date Equality Impact Assessment Undertaken Group completing Equality impact assessment Please enter any keywords to be used in the policy search system to enable staff to locate this policy Fundraising. Charity. Charitable Funds Database No: Page 2 of 19 Version 1
Document Implementation Plan How Will This Policy Be Implemented? Internet, training, induction, word of mouth. Who Should Use The Document? All staff. What (if any) Training/Financial Implications are Associated with this document? None Action By Whom By When What are the Action Plan/Timescales for implementing this policy? Database No: Page 3 of 19 Version 1
CONTENTS 1. Introduction 5 2. Policy statement 5 3. Scope 5 4. Aims 6 5. Objectives 6 6. Charitable donations 6 7. Acceptable fundraising activities 6 8. Fundraising by individual staff members 8 9. Fundraising by friends & supporters / Third party fundraising 8 10. Fundraising within wards and departments 9 11. Fundraising projects and appeals 9 12. Fundraising by partner charities and joint party fundraising 10 13. Fundraising by other charities 11 14. Data protection and fundraising standards 11 15. Approval of fundraising activities 12 16. Fundraising support 12 17. Receiving donations or legacies 13 18. Donated items and gifts in kind 13 19. Sponsorship 13 20. Gift Aid 13 21. Expenditure from charitable donations 14 22. Monitoring and review 14 23. Further information 14 24. Review 15 Appendix 1 Fundraising Registration Form Appendix 2 Example donation thank you letter Appendix 3 Making a donation - Gift Aid declaration 16 18 19 Database No: Page 4 of 19 Version 1
1. INTRODUCTION Hywel Dda Health Charities (the charity) is the official charity of Hywel Dda University Health Board (UHB), registered charity number 1147863. The charity and UHB is duty bound to ensure that the correct controls and governance arrangements exist with regards to all aspects of fundraising. The aim of this policy is to outline the key principles and practices that will govern the approach to the management of all fundraising activity undertaken to ensure that the charity and fundraisers work in a way that complies with good practice. 2. POLICY STATEMENT This policy outlines the principles and practices that will govern the approach to the management of all fundraising activity undertaken for Hywel Dda Health Charities. The policy is written in accordance with legislation that impacts on the UHB and any fundraising undertaken on its behalf. This policy applies to all staff who have an involvement with patients, their families and local communities raising funds for their particular areas of work. This policy should be read in conjunction with: 1. Hywel Dda Health Charities Policy & User Guide. 2. Charitable Funds Financial Procedure. The policy outlines our approach to the management of all fundraising activity undertaken to ensure that the charity and fundraisers work in a way that complies with good practice. 3. SCOPE This policy applies to: 1. All UHB staff actively involved in fundraising for Hywel Dda Health Charities and those who handle charitable monies: a. in which the charity, UHB or any of its services is named as a primary beneficiary. b. where the UHB s official charity name is used. c. any fundraising event undertaken by staff on UHB premises. 2. Members of the public fundraising for Hywel Dda Health Charities. Fundraising should be undertaken by individuals over 18, please contact us if children are to be involved in fundraising. Database No: Page 5 of 19 Version 1
4. AIMS HYWEL DDA UNIVERSITY HEALTH BOARD This policy aims to provide comprehensive guidance to all staff on our approach to the management of all fundraising activity to ensure that the charity and fundraisers work in a way that complies with good practice. 5. OBJECTIVES The policy will protect the UHB and its staff from liability by ensuring that all fundraising activities undertaken are within the law. 6. CHARITABLE DONATIONS The UHB supports the work of Hywel Dda Health Charities to raise money from charitable donations to help keep the UHB s services at the highest standards by: Supporting healthy living and health promotion. Helping to maintain the best possible environment for care, including building and refurbishing hospital and community facilities. Funding the most up-to-date equipment. Supporting the training and development of staff. Supporting research into, and development of, treatments. The UHB acknowledges that charitable donations do not replace NHS funding but are used to support the UHB to provide services and activities above and beyond what the NHS in Wales can provide. The Director of Finance and Economic Reform of Hywel Dda University Health Board, under a scheme of delegated authority approved by the Corporate Trustees, has day-to-day responsibility for the management of the charitable monies. The UHB delegates responsibility for the management of the charity and its funds to the Charitable Funds Committee. The trustees and those with delegated authority are responsible for ensuring that: Fundraising is carried out legitimately. Expenditure is properly validated. All funds raised are accurately accounted for. The money is expended in accordance with the objectives of the fundraisers/donors. 7. ACCEPTABLE FUNDRAISING ACTIVITIES The UHB approves fundraising activities where the giving of funds is linked to an activity rather than a general request for funds. Those events that have an added health benefit for recipients are positively encouraged. Database No: Page 6 of 19 Version 1
For example: Local and national health related awareness campaigns that can be linked to business areas and strategic plans. E.g. Breast Cancer Month to the Breast Cancer Funds, Prostate Cancer Awareness to Urology Funds. Fundraising for funds linked to an activity in your department. E.g. Sponsored cycle for your ward or department. Fundraising activities where money is raised for a UHB ward or department must be linked to a specific activity, for example a piece of equipment which will directly benefit patients or provide enhancements to your services. Entering externally organised challenges/events to raise funds. E.g. Sponsored cycle, Cardiff Half Marathon, Christmas Day Swim, skydive. Additionally, we support staff fundraising for partnership events. For example: National Charity Event Days such as Red Nose Day, Children in Need, Sport Relief, Genes for Jeans Day. Fundraising activities to support charities based on UHB premises or supporting our services. E.g. RVS, Ty Bryngwyn, Ty Cymorth, Canolfan Plant etc. Proposed fundraising activities undertaken by UHB staff must not attract adverse publicity for the UHB. Fundraising activities that meet with public disapproval can damage the reputation of both the UHB and the charity. The Fundraising Team can provide UHB staff and our supporters with help and advice on any fundraising activity and must approve events prior to them being undertaken. The UHB needs to protect the integrity and reputation of its staff and services and it is therefore essential that the use of the charity name has prior approval. The Fundraising Team must be made aware of all planned events, both internal and external, and must provide approval which is maintained via a centralised fundraising event log. Staff and members of the public wishing to organise fundraising or events will, in the first instance be required to complete for approval the Fundraising Registration Form (appendix 1) and forward to The Fundraising Team, Hywel Dda Health Charities, Hafan Derwen, Parc Dewi Sant, Jobswell Road, Carmarthen, SA31 3BB or by email to Fundraising.HywelDda@wales.nhs.uk. Once an activity has been approved, fundraising publicity must state: 1. Who will benefit from the fundraising activity. 2. Where the money will go to: a. E.g. Hywel Dda Health Charities 1147863 Urology Fund and where possible what will be purchased with the money raised. Database No: Page 7 of 19 Version 1
b. For external charities, you must include their registered charity number but also seek approval for them directly for your fundraising & publicity. 8. FUNDRAISING BY INDIVIDUAL STAFF MEMBERS The participation in fundraising activities by staff is voluntary and should not be imposed on any individuals. An individual member of staff fundraising for their particular ward or department on site is acceptable as long as it does not interfere in their scheduled hours of work. For example, seeking sponsorship from your colleagues for an activity you are doing to raise money for a piece of equipment should be done during break times. Where individual staff members are fundraising for the UHB s wards or departments they must notify the charity who will be able to assist, advise and/or support the event. Please contact the Fundraising team on Fundraising.HywelDda@wales.nhs.uk or 01267 239815 (WHTN 01825 4815). Any member of UHB staff may apply to raise funds on behalf of a service, however, the intention to raise funds should also be relayed to the individual s line manager. Where a UHB employee is involved in fundraising activities that have not been approved by the Fundraising Team support must be obtained offsite and out of working hours. 9. FUNDRAISING BY FRIENDS & SUPPORTERS / THIRD PARTY FUNDRAISING Any member of staff who receives an enquiry from an external party wishing to raise funds directly for either the UHB or a specific ward or department must refer the enquiry to the Fundraising Team on 01267 239815 (WHTN 01825 4815) or Fundraising.HywelDda@wales.nhs.uk for advice and assistance. The Fundraising Team will then liaise with the individual or organisation to approve the fundraising activity, provide advice to the fundraiser and enable the UHB to monitor all fundraising activity. Staff members may from time to time receive requests to become involved in fundraising activities for friends or other charities you support. The UHB does not have insurance cover to hold these activities onsite on behalf of these parties. Employees participating in fundraising events arranged by other charity organisations or activities of their friends must do so in their own time and offsite. You should check that the organisations have carried out a suitable risk assessment and carry the appropriate insurance. The UHB will not normally pay for professional fundraisers. The use of professional fundraisers must be agreed by the Charitable Funds Committee. Any request for additional fundraising support must consider whether there are suitable staff resources within the UHB or whether the Fundraising Team can undertake the duties required. Database No: Page 8 of 19 Version 1
10. FUNDRAISING WITHIN WARDS AND DEPARTMENTS The intention of the UHB is to support wards and departments to increase their fundraising activities and to maximise opportunities for donations to Hywel Dda Health Charities. Collectively staff may undertake fundraising activities where money is generated for their own ward or department or another area of the UHB. The fundraising activity should ideally be linked to an activity or campaign (for example purchase of vital piece equipment) and must not conflict with other fundraising plans and priorities. This provides excellent opportunities to support strategic fundraising objectives and areas where fundraising support is required. The Fundraising Team must be informed of any planned fundraising activity to take place within your ward or department, in order to co-ordinate any activity where necessary and to provide advice and assistance with the marketing and promotion of the event both internally and externally and to ensure all fundraising is completed using UHB standards. Please complete a Fundraising Registration Form for approval (appendix 1). The UHB actively encourages its staff to participate in/or organise fundraising on behalf of the service. It is necessary, however, to ensure that both the UHB and its staff comply with statutory regulations and recommended practice during such activities. Fundraising must not take place in your ward at the bedside; this is to protect patients who may be considered vulnerable. Remember that the principle aim of any event is to obtain the maximum return possible and expenditure incurred should be minimal and proportionate to the event itself. The Fundraising Team can provide an event budget template to support the maximisation of income and donations. Staff members may display information regarding their fundraising activity across the UHB. The Fundraising Team can assist with this and provide templates and logos for marketing materials etc. Staff must not directly approach patients or visitors to suggest or request involvement or contributions. If patients or visitors approach a member of staff regarding the fundraising activity they may accept offers of participation and support. No collection tins should be displayed within the ward or department without prior permission from the Fundraising Team, please contact us to request charity collection tins. 11. FUNDRAISING PROJECTS AND APPEALS It is a requirement that a small committee (up to 4 staff members) is formed to manage and administer fundraising appeals and major events where there is an expected income of more than 5,000. This helps spread the workload and allows the committee to delegate responsibilities to different individuals, i.e. a Finance Officer, Fundraising Officer, etc. Database No: Page 9 of 19 Version 1
Where there is an appeal committee, a member of the Fundraising Team should also be involved to support the scheme and tie any activities into the charity s overarching campaigns and work. The Fundraising Team can co-ordinate branded marketing and materials to support the appeal. It is recommended that if a committee has been set up to organise an event/appeal, a named individual must be nominated to administer the collection and record and secure all funds. It will be the responsibility of that individual to keep an accurate record of funds raised and any expenditure incurred, and to forward a copy to the Fundraising Team. For major events organised by a committee, the nominated individual should discuss and agree any expenses, which may arise. This should be reported to the Fundraising Team to seek approval for the fundraising to be set up as an appeal. 12. FUNDRAISING BY PARTNER CHARITIES AND JOINT PARTY FUNDRAISING There are a number of organisations who raise money solely or mainly in support of the UHB s services (i.e. RVS, League of Friends etc). The charity aims to give these groups ( partner charities ) full support in their fundraising activities. All hospital based charities must contact the Fundraising Team before putting up any long term advertising (i.e. signage, sculptures, display boards) across the UHB sites in general and in office and ward locations. The charity will review the items and approve or decline any such short or long-term fundraising items in accordance with our objectives. On occasion, the UHB may adopt a partnership approach to fundraising by strengthening relationships and improving communication with a range of partners leading to an increase in fundraising activity and the number of individual donations. Joint fundraising events will be encouraged and proceeds must be shared according to any prior rates agreed between the UHB charity and the fundraising partner organisation. The Fundraising Team must be informed of any planned joint fundraising activity to take place, in order to co-ordinate any activity where necessary and to provide advice and assistance with the marketing and promotion of the event both internally and externally. Where a local charity or community partnership engages in a venture where contributions are to be given to the UHB, a signed written agreement must be in place containing provisions to include: The purpose for which the fund is being sought. How monies will be split between organisations. An explanation of how any surplus money will be used. The Fundraising Team must approve all literature naming the UHB as the beneficiary and review the financial arrangements of any major partnership fundraising schemes. Database No: Page 10 of 19 Version 1
13. FUNDRAISING BY OTHER CHARITIES Any fundraising by external charities should be approved by the Fundraising Team. Only Hywel Dda Health Charities collecting boxes are permitted on any UHB site unless permission has been granted by the Fundraising Team. Partner charities may display their collection tins in approved locations by prior agreement. 14. DATA PROTECTION AND FUNDRAISING STANDARDS Data Protection legislation affects many areas of fundraising. Fundraisers need to ensure they comply with the regulations. The Data Protection Code of Fundraising Practice identifies key regulatory and best practice standards for fundraising. The regulations may appear daunting at first but it is helpful to remember a few rules of thumb: Ensure you have the necessary permissions to contact supporters. Do not retain any information on an individual that you would not be comfortable sharing with them. Do not use information in a manner that the supporter would not wish. Do not share data in a manner that a supporter would not wish. In short, it is helpful to think about how you would like your details used by another organisation. For more information about Data Protection guidelines and fundraising please visit: www.institute-of-fundraising.org.uk/guidance/about-fundraising/data-protection. All fundraising activity for Hywel Dda Health Charities must comply with: The Charities Acts of 1992, 1993, 2006 and 2011. Charity Commission regulation. Data protection law. Local county council licensing requirements. Gambling Act 2005. Hywel Dda Health Charities is a member of the Institute of Fundraising. Fundraising activity at UHB must comply with the UHB income generation governance and ethical framework policy. Hywel Dda Health Charities is able to provide either formal authorisation letters or ID badges for individuals in order to fundraise in public places. Thank you letters must be issued for all donations received into the UHB by individual wards or departments. It is therefore necessary to accurately and legibly complete the Donation Book with full donor information. A template for a general thank you letter is attached in Appendix B. Database No: Page 11 of 19 Version 1
15. APPROVAL OF FUNDRAISING ACTIVITIES All potential fundraising activities undertaken by individual UHB employees or wards/departments must be approved by the Fundraising Team. The safety and security of staff involved in fundraising activities (and that of the general public) is of primary importance and careful consideration should be given to such issues. If necessary, appropriate insurance should be in place to cover against such contingencies. The UHB holds insurance for low risk fundraising activities that are undertaken by UHB employees and on UHB sites. Please liaise with the Fundraising Team to identify the level of insurance required for your event and how to obtain this. For large scale events and those of medium high risk, a separate insurance policy should be obtained to ensure appropriate cover. Submissions for approval of fundraising (whether by members of staff or external bodies) should include the following detail: The fund your activity will support. How the money will be raised (collections, raffles, appeal, etc) and in what timescale. Estimated income and expenditure for your activity. Proposed source of funding if any cost is additional to that covered by fundraising (i.e. application for a grant, or using an endowment fund). For any equipment to be funded, the lifespan and a proposed source of eventual replacement. The Fundraising Team will then either authorise the fundraising or seek official authorisation for larger scale fundraising with the appropriate channel (i.e. via the Charitable Funds Committee to set up a specific appeal). Fundraising activities will be recognised so long as they are generally within the strategic direction of the corporate objectives and business priorities. Certain activities will require the approval of the Charitable Funds Committee prior to commencement. Those needing the higher approval include, for instance: Higher risk activities that require additional insurance cover. Fundraising that has a revenue consequence (i.e. for a piece of equipment, for staffing etc). All appeal committees will be required to submit progress updates for inclusion within the Fundraising Report for the Charitable Funds Committee. 16. FUNDRAISING SUPPORT Please contact the Fundraising Team in the following instances: If you are approached by an external organisation who wish to support the charity, including your ward or department. Database No: Page 12 of 19 Version 1
You wish to approach an organisation for support. This includes approaching them for sponsorship, financial support, gifts in kind etc. You are selling any items on behalf of the charity. The Fundraising Team will require reassurance that the nature of support is in line with both the charitable objectives of the organisation and the governance framework. Where there is a significant opportunity to receive income, capital, or long term support from a third party, a business case will be submitted as part of the Fundraising Report to the Charitable Funds Committee for consideration and approval. 17. RECEIVING DONATIONS OR LEGACIES Any member of staff receiving a donation or notification of a legacy should follow the guidance given in the Charitable Funds Administration & Governance Financial Procedure. Insert link when approved 18. DONATED ITEMS AND GIFTS IN KIND All potential donated assets (medical equipment, furnishings) and gifts in kind must follow the guidance given in the Standards of Behaviour Policy: http://www.wales.nhs.uk/sitesplus/862/opendoc/194804 19. SPONSORSHIP All potential sponsorship agreements must be in line with the Sponsorship by the Private Sector Policy: http://howis.wales.nhs.uk/sitesplus/documents/862/095fp1601sponsorshipbytheprivatesecto r.pdf 20. GIFT AID Staff are encouraged to help the charity add 25p to every pound donated, at no extra cost to the donor by asking all donors to sign and complete the Gift Aid declaration in every donation book or the form in Appendix 3. If donors give 1 in the normal way Hywel Dda Health Charities will receive precisely 1. If donors Gift Aid their donations then Hywel Dda Health Charities will receive 1.25 - in other words increasing the value of their gift by nearly a third. Anyone who has paid enough income tax or capital gains tax to cover the amount reclaimed by Hywel Dda Health Charities in the current financial year can use Gift Aid. Higher rate taxpayers can reclaim 18 per cent personal tax relief on donation - 23p in every pound donated. 21. EXPENDITURE FROM CHARITABLE DONATIONS Database No: Page 13 of 19 Version 1
Details on how to request expenditure from charitable donations are available in the Hywel Dda Health Charitable Funds Policy. Insert link when approved 22. MONITORING AND REVIEW Staff engaged in any fundraising event in which the UHB s hospitals or services are quoted as a beneficiary must have prior agreement from the Fundraising Team. Where it is apparent that such an agreement is not in place, the Fundraising Team will follow this up and if necessary report to the Charitable Funds Committee. Fundraising events and lotteries are subject to review by the Fundraising Team. In addition enquires are regularly received from the Local Licensing Authority and the Police requiring confirmation or validity of an event. Income from fundraising events that have been agreed through the Fundraising Team is monitored by the Finance Team and reported to the Charitable Funds Committee on a quarterly basis. Any outstanding events will be followed up within a reasonable time period (in relation to the type and complexity of the event) and any issues of concern will be raised with the individual fundraisers and may be reported to the Charitable Funds Committee. Raffle and Lottery returns together with any unsold tickets should be returned to the Fundraising Team within an agreed timescale (usually within 4 weeks of the draw taking place), as this information must be relayed to the Local Licensing Authority. Any differences or queries will be taken up with the nominated member of staff responsible and if necessary reported to the Charitable Funds Committee. A final confirmation of the income and expenditure around a fundraising event or campaign should be submitted to the Fundraising Team in order to keep a centralised record of all activities. This will help us to control any publicity and further promote the success of your event to our stakeholders. The Fundraising Team will follow up any overdue information and investigate any discrepancies or errors. 23. FURTHER INFORMATION The Fundraising Team: Nicola Llewelyn Hafan Derwen, Carmarthen Email: nicola.llewelyn@wales.nhs.uk WHTN: 01825 4815 Tel: 01267 239815 Mobile: 07884 362849 Claire Rumble Block 6 Prince Philip Hospital, Llanelli Email: claire.rumble@wales.nhs.uk WHTN: 01824 3637 Tel: 01267 239815 Mobile: 07557 499029 Database No: Page 14 of 19 Version 1
24. REVIEW This policy will be reviewed after three years, or sooner, as required. Database No: Page 15 of 19 Version 1
Appendix 1 HYWEL DDA UNIVERSITY HEALTH BOARD Hywel Dda Health Charities Fundraising Registration Form 1. About you Lead contact name: Doing your own fundraising? Please tell us about it! Contact address: Post code: Telephone: Mobile: Email: 2. What is your connection to Hywel Dda Health Charities? Former patient Family of patient Friend of patient Member of staff Local resident Community group Other 3. Why have you chosen to support Hywel Dda Health Charities? If your event/activity is in memory or celebration of someone s life, please let us know Database No: Page 16 of 19 Version 1
4. Please tell us about the event or activity and how you plan to fundraise 5. Date and location of proposed event or activity 6. What is your fundraising target? 7. Please tell us where you would like us to direct the proceeds of your fundraising It is my / our wish that the proceeds of the fundraising are used for: Response Fund (Please use my donation where it is most needed) or Named department/service: Signature: Date: Please return this form to: The Fundraising Team Hywel Dda Health Charities Hafan Derwen, Parc Dewi Sant, Jobswell Road, Carmarthen, SA31 3BB Tel: 01267 239815 WHTN: 01825 4815 Email: Fundraising.HywelDda@wales.nhs.uk Database No: Page 17 of 19 Version 1
Appendix 2 HYWEL DDA UNIVERSITY HEALTH BOARD Example donation thank you letter Address Date Dear XX Fundraising in aid of Special Care Baby Unit, Glangwili Hospital I am writing on behalf of the Special Care Baby Unit (SCBU) at Glangwili Hospital to thank you for your recent fundraising which raised a fantastic 565 for the Unit. Your donation to SCBU will be used to enhance the care provided at the Unit and will ensure that patients, their families and staff can access a wide range of specialist services and equipment beyond what the NHS can provide. Hywel Dda Health Charities is a registered charity established to support the work of Hywel Dda University Health Board. The charity uses donations received from patients, their families and local communities to improve services for the benefit of the thousands of people cared for each year in our local communities. We are registered as one charity made up of many funds for various wards, departments and services across all hospitals and community venues in Carmarthenshire, Ceredigion and Pembrokeshire. Your donation will not replace NHS funding but will be used support the work of the University Health Board to provide services and activities above and beyond what the NHS in Wales can provide. We are extremely grateful for your generosity. Kind regards Name Job title Database No: Page 18 of 19 Version 1
Appendix 3 Making a donation - Gift Aid declaration Please use this form to make your gift go further. Name of charity: Hywel Dda Health Charities. Registered Charity no: 1147863 Please treat: (Please tick the appropriate box) 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 or Community Amateur Sports Clubs (CASCs) 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. 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. Donor s details: Title --------- 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. Note: If you pay Income Tax at the higher rate, you must include all your Gift Aid donations on your Self Assessment tax return if you want to receive the additional tax relief due to you. For more information visit the Inland Revenue website. Please return this form to: Nicola Llewelyn, Fundraising Officer Hywel Dda Health Charities, Hafan Derwen, Parc Dewi Sant, Jobswell Road Carmarthen, SA31 3BB Database No: Page 19 of 19 Version 1