CICC Standing Order & Gift Aid
(Version 1.0)

Colchester Islamic Community Centre
Charity Number :- 1175376
Email address :- info@ciccentre.org
Postal Address :- Vicarage, Ivy Lodge Road, CO6 4EN

CICC
This is the CICC Standing Order & Gift Aid application form. Please ensure you read the conditions associated with this application at the end of the form. (This is best done on a large PC screen.)
Title *
First Name *
Your answer
Surname *
Your answer
Phone Number (mobile preferred) *
Your answer
Email *
Your answer
Postal Address *
Your answer
Post Code *
Your answer
Gift Aid
(please read full Gift aid text at end of page )
In order to Gift Aid your donation you must select this box :-
Standing order Information
I want to make :- *
of value £
Your answer
On the following day of next/each month *
Your answer
Your bank details
Name of bank/building society *
Your answer
Bank Address *
Your answer
Bank Post Code *
Your answer
Name of Account holder *
Your answer
Bank Sort Code *
Your answer
Bank Account Number *
Your answer
Reference (please put name & postcode)
Your answer
Payments to be made to CICC Account
Name CICC Property AC
Sort Code 20-45-45
Number 03922820
Signature & Date
This information will be printed out and you will be asked to sign the form, so CICC can submit to you're bank.
Todays Date
MM
/
DD
/
YYYY
Data Protection statement :-
Any data submitted will be held in a CICC database. It will only be used by the Trustees and the Core Group for CICC related activities. It will not be shared with third parties. All information provided will be treated in confidence.
Charity Gift Aid Form – multiple donation
Boost your donation by 25p of Gift Aid for every £1 you donate. Gift Aid is reclaimed by the charity from the tax you pay for the current tax year. Your address is needed to identify you as a current UK taxpayer.

(Tick box moved to address section above.)

I am a UK taxpayer and understand that if I pay less Income Tax and/or Capital Gains Tax than the amount of Gift Aid claimed on all my donations in that tax year it is my responsibility to pay any difference.

My Details (provided in address section above)

Please notify the charity if you: (i) want to cancel this declaration (ii) change your name or home address, (iii) no longer pay sufficient tax on your income and/or capital gains. If you pay Income Tax at the higher or additional rate and want to receive the additional tax relief due to you, you must include all your Gift Aid donations on your Self-Assessment tax return or ask HM Revenue and Customs to adjust your tax code.

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