Enrolment Form
Please print this form out, fill it in and send it to The Settlement.
Surname: ____________________ Title: __________ Forename: ____________________
Address: ______________________________________________________
_______________________________________________________ Postcode: ________________
Telephone (day): ____________________ Evening: ____________________ Membership Number: __________
Membership Fee already paid for 2007/08? (please tick) __ If not, please include payment with enrolment.
Student's Signature: __________________ Date: _______ Data Protection Act: Some information may be held, for Settlement use only, in a database registered under the Data Protection Act. Your signature above indicates your approval.
Where did you first hear about the courses held here? (please underline):
Our website, our brochure, word of mouth, Madingley brochure, newspaper advert, other (please specify)
BANKER'S ORDER FORM
To: The Manager, ____________________________________ (Name of your bank) of ___________________________________________________ (Address of your bank) Account number: _____________________ Sort code: __________ Please pay Letchworth Adult Education Settlement annually the sum of £________ from the first day of ___________ (month and year) until ________ / further notice. (Delete as appropriate)
CAF Bank Ltd
Sort Code 40-52-40 Letchworth Adult Education Settlement Account: 00011799 Name: ___________________ Address: ______________________________________ ____________________________________ Signature: ____________________ Date: ___________
Signature: __________________________________ Date: ____________________ Please read the notes below carefully.
GIFT AID NOTES 1. If your declaration covers donations you may make in the future: a) Please let Letchworth Settlement know if you change your name or address while the declaration is still in force.
b) Cancellation of declaration:
You can do this at any time by notifying Letchworth Settlement; it will then not be applicable to donations
you make on or after the date of cancellation. 2. You must pay an amount of Income Tax and/or Capital Gains Tax at least equal to the tax Letchworth Settlement reclaims on your donations in the tax year (currently 28p for every £1 you donate). 3. If your circumstances change in the future and you no longer pay tax on your income and/or capital gains equal to the tax that Letchworth Settlement reclaims, you can cancel your declaration. 4. If you pay tax at the higher rate you can claim further tax relief in your self-assessment tax return. 5. If you are unsure whether your donations qualify for Gift Aid tax relief, consult Letchworth Settlement. Alternatively leaflet IR113 (Gift Aid) may be obtained from your tax office.
- I wish to make a donation and enclose __________
- I wish to pay by Standing Order and have completed a Banker's Order Form below (please tick) ___
| Course Details | Fee Payable |
|---|---|
|
Course Title (1) ____________________________________
Day _____________ Time __________ |
|
|
Course Title (2) ____________________________________
Day _____________ Time __________ |
|
|
Course Title (3) ____________________________________
Day _____________ Time __________ |
|
| Annual Membership Fee Due: £18.00 (standard); £13.00 (concessions — over 60) | |
|
Payment method: Cash/Cheque TOTAL FEES PAYABLE
Make cheques payable to Letchworth Settlement. |
Student's Signature: __________________ Date: _______ Data Protection Act: Some information may be held, for Settlement use only, in a database registered under the Data Protection Act. Your signature above indicates your approval.
Where did you first hear about the courses held here? (please underline):
Our website, our brochure, word of mouth, Madingley brochure, newspaper advert, other (please specify)
BANKER'S ORDER FORM
To: The Manager, ____________________________________ (Name of your bank) of ___________________________________________________ (Address of your bank) Account number: _____________________ Sort code: __________ Please pay Letchworth Adult Education Settlement annually the sum of £________ from the first day of ___________ (month and year) until ________ / further notice. (Delete as appropriate)
CAF Bank Ltd
Sort Code 40-52-40 Letchworth Adult Education Settlement Account: 00011799 Name: ___________________ Address: ______________________________________ ____________________________________ Signature: ____________________ Date: ___________
GIFT AID DECLARATION
I am a United Kingdom payer of Income Tax and I wish Letchworth Settlement to treat all donations I have made since 6th April 2000, and all donations that I make hereafter until I notify you otherwise, as Gift Aid Donations.Signature: __________________________________ Date: ____________________ Please read the notes below carefully.
GIFT AID NOTES 1. If your declaration covers donations you may make in the future: a) Please let Letchworth Settlement know if you change your name or address while the declaration is still in force.
b) Cancellation of declaration:
You can do this at any time by notifying Letchworth Settlement; it will then not be applicable to donations
you make on or after the date of cancellation. 2. You must pay an amount of Income Tax and/or Capital Gains Tax at least equal to the tax Letchworth Settlement reclaims on your donations in the tax year (currently 28p for every £1 you donate). 3. If your circumstances change in the future and you no longer pay tax on your income and/or capital gains equal to the tax that Letchworth Settlement reclaims, you can cancel your declaration. 4. If you pay tax at the higher rate you can claim further tax relief in your self-assessment tax return. 5. If you are unsure whether your donations qualify for Gift Aid tax relief, consult Letchworth Settlement. Alternatively leaflet IR113 (Gift Aid) may be obtained from your tax office.