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Declaration

To:

Trustees of the Kerry Green Trust
203 Carisbrooke Road
Newport
Isle of Wight
PO30 1DJ

From:

Name
Address 1
Address 2
Address 3
Post Code
Date

Declaration: Donations to Kerry Green Trust

I am a taxpayer and confirm that I want the Kerry Green Trust to reclaim Income Tax on all donations I have made since 6th April 2000, and all donations I make from the date of this declaration until I notify you otherwise.

I confirm that I will only make payments to the Trust under this declaration which have suffered income and/or capital gains tax.

I also confirm that I will notify the trust of any change in my name or address and understand that I may cancel this declaration at any time by writing to the Trust.

Yours faithfully

(signed) . . . . . . . . . . . . . . . . . . . . . .