The New Victoria Medical Foundation

Standing Order Mandate
Medical support transporting lives
Please complete this form and return it by post to: Lorna Votier, Development Director,
The Victoria Foundation, St David’s House, 15 Worple Way, Richmond, Surrey. TW10 6DG.
If you are a UK taxpayer for every pound you give to us, we can claim back 25p from HMRC. I declare that all
donations I make from the date of this donation until I notify you otherwise are Gift Aid donations. I understand to
qualify for Gift Aid I must pay an amount of UK Income Tax and / or Capital Gains Tax at least equal to the tax that
the charity reclaims on my donations in the appropriate tax year.
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If you are happy to be contacted by telephone or email please include your contact details below:
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Donation details
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Each year:
until I cancel.
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Please Pay:
For Office use only
The Victoria Foundation
HSBC Bank plc, Kingston Branch
Account No: 01563327
Sort Code: 40-26-12
The Victoria Foundation Limited
A Company limited by guarantee registered in England No: 1946612
Registered office: St David's House, 15 Worple Way, Richmond, Surrey TW10 6DG.
Registered Charity number: 292841
01/01/17
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