Payroll pledge form

Every day 100 people in the UK start losing their sight.

Right now RNIB can only reach one in three of the people who need our help most. Support RNIB and help us reach them all.

I wish to give tax-free every month from my pay to RNIB.

Amount:

If you have selected other, please specify amount you would like to donate:

Title:

First name:

Surname:

Email:

I would like to be kept up to date with RNIB news and activities.

Daytime telephone number:

Employee number:

Employer/Pension provider:

Payroll department address line 1:

Payroll department address line 2:

Payroll department address line 3:

Payroll department town/city:

Payroll department county:

Payroll department postcode:

Home address line 1:

Address line 2:

Address line 3:

Town/City:

County:

Postcode:

Format required:

Any questions or comments

Declaration

Please deduct the total amount above from my gross pay every month as a gift to Royal National Institute of Blind People. I confirm that my understanding is that no further tax is recoverable on this gift. I understand that no gift can be made as a membership subscription or to pay for goods or services supplied.

I agree to the above declaration