Rokpa UK Overseas Projects: Single Donation Form - Print Version

Gift Aid Option: Gift Aid increases the value of your donation by 28%

I (full name) _________________________________________________________

of (address) _________________________________________________________

________________________________________________________________

__________________________________ Post Code ___________________

would like Rokpa Trust to treat all my donations from April 6^th 2000 onwards as Gift Aid donations until further notice. I confirm that I am a UK tax payer and the amount of income tax and/or capital gains tax I pay exceeds the sum of tax to be reclaimed in the tax year.

Signed ________________________________________ Date _______________

I enclose a cheque for £_____________ (please make cheques payable to: Rokpa UK)

Or please charge my CAF/Credit/Debit Card

Card Number:

Valid From: Expiry Date: Security number:

Signed__________________________________________ Date______________

Mrs/Mr/Miss/Ms_____________________________________________________

Address ___________________________________________________________

___________________________________________________________________

Post Code ________________ Email __________________________________

Use my donation for projects in:

Tibetan Areas of China Nepal Zimbabwe South Africa

OR use my donation specifically for:

The Tibet Healthcare Project

The EyeCare Project (Project No. 8011)
Sponsor a local clinician to work in the hospital (Project No. 7673)
Sponsor an orphanage student to degree level (Project No. 7674)

OR ALLOW ROKPA UK TO DECIDE THE BEST USE FOR MY DONATION

Please return this form to: Rokpa UK Overseas Projects, Kagyu Samye Ling, Eskdalemuir, LANGHOLM, Dumfriesshire DG13 0QL