The Cystinosis Foundation UK - Gift Aid Declaration


Title:       ...... 

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

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

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

             ...............................................................
             
             ............................................................... 

             Post Code:............. 


I am a UK taxpayer and I want the Cystinosis Foundation UK to treat all 
donations I have made since April 2005, and donations I make from the date of 
this declaration, until I notify you otherwise, as Gift Aid donations. I 
understand I can withdraw this consent whenever I so wish.


SIGNED:      ...............................................................


DATE:        ....../....../......