Name: ......................................................................................................
.
            Home address: 
...
            .................................................................................................................................
            .............................................................. 
              postcode:.
......................
            E-mail: .....................................................................................................................
            Sum donated: ..........................................................................................................
            Signed: 
 
              Date: 
.
            I want the charity to 
              treat
             *the enclosed donation 
              of £ 
 as a Gift Aid donation
            *the donation(s) of £ 
              
which I made on 
/
/
 as (a) Gift Aid donation (s)
            *all donations that I 
              make from the date of this declaration until I notify you otherwise 
              as Gift Aid donations
            *all donations I have 
              made for this tax year and the six years prior to the year of this 
              declaration, (but no earlier than 6/04/2000) and all donations I 
              make from the date of this declaration until I notify you otherwise, 
              as Gift Aid donations.
            
              *delete as appropriate
             
            Note: 
              You must pay an amount of Income Tax and/or Capital Gains 
              Tax at least equal to the tax that the charity reclaims on your 
              donations in the appropriate tax year (currently 25p for each £1 
              you give).
            
            Please send your donation to Prof. 
              Jonathan Prag, Merton College, Oxford OX1 4JD, United Kingdom. Cheques 
              should be made payable to Thomas Wiedemann Memorial Fund.
            For more information on Gift Aid, see 
              the relevant pages of the Inland 
              Revenue website.