Make a regular donation form

Make a regular donation

Your donation will make a lasting difference for hospice care. Make a regular donation and support hospice care so that everyone who needs hospice care, gets it.

Source Code*
Destination Code*
How much would you like to donate per month (in £)?
Donation amount
My donation is*
If you're making a general donation, you can tell us a bit more about it here

Your in memory donation

Please tell us a bit more about your donation
This donation is in memory of
This person is my
If you'd like to leave a message, please write it here

Your in celebration donation

Please tell us a bit more about why you are donating
What special occasion are you celebrating?
Who are you donating in celebration of?
When is the celebration taking place?

DayMonthYear
Date
If you'd like to leave a message, please write it here

Your name and address details

Let us know a bit more about yourself
Your name*

First NameLast Name
Email*
example@example.com
Telephone number
Keep in touch

By ticking this box, you agree to receive regular email updates
I would like to keep in touch by post

By ticking this box, you agree to receive updates from us by post
Address

Street Address

Street Address Line 2

CityCounty

Postcode

Make your regular online donation

Donation amount*

I would like to make a regular donation ofThe amount should be pre-selected below

GBP for each month

Total

£0.00

Payment Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Gift Aid

By adding a Gift Aid declaration to this donation, you can add an extra 25% to the amount, at no additional cost to yourself.

To Gift Aid your donation, please confirm the statement below:

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

Hospice UK will treat as Gift Aid donations all qualifying gifts of money made to Hospice UK, today, in the past 4 years and in the future. Please contact Hospice UK if you do not want this to apply to your future or past donations.

Please notify Hospice UK if you: want to cancel this declaration / change your name or home address / no longer pay sufficient income or capital gains tax.
I have read the above statement and:*

Yes, I would like to make a Gift Aid declarationNo, I am unable to create a Gift Aid declaration
Should be Empty:

Make a regular donation

Your in memory donation

Your in celebration donation

Your name and address details

Make your regular online donation

Gift Aid