From: (Mr. Mrs. Ms. Miss)
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I would like to support The Lake Clinic-Cambodia. Here is my gift of £
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I am a UK tax payer and I wish all donations I have made to the IMPACT foundation in the last four years and all donations I make hereafter to be treated as Gift Aid donations (please tick). 
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Please remember to notify us if you no longer pay an amount of income tax or capital gains tax equal to the tax we claim on your donations (28p for every £1 you give), or if your name or address changes. You may cancel this declaration at any time by writing to us.
Please cross cheques and postal orders and make them payable to the IMPACT Foundation
Please send me more information about:
IMPACT  Leaving a Legacy  Tax-effective Giving Donating Shares

Please return to:
Mrs. Judi Stagg, Chief Executive
IMPACT/TLC, 151 Western Road, Haywards Heath, West Sussex, RH16 3LH, UK.

Registered Charity No. 290992.

 Thank you

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