Surname:..................................................................................................................

Forename(s):............................................................................................................

Address:...................................................................................................................

Postcode:..................................... Telephone number:............................................

I want the Lions part to reclaim tax on this donation of £.......... and any I make hereafter, all of which are to be treated as GIFT AID DONATIONS until I notify the charity otherwise.

Signed: ..............................................

Date: ..............................................

Please return the completed form to:

The Treasurer,
the Lions part,
44 Holmewood Road,
London,
SW2 3RR


For completion by the Lions Part:

Donation record number:

Information checked: