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: ....../....../......