This icon of St Barnabas is reproduced from an original by Sr Petra Clare, The Benedictine Skete, Marydale, Cannich, Beauly, Inverness shire IV4 7LT

This declaration may only be made by taxpayers.

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Donor's Full Name:
Donor's Address:
Post Code:
All the donations I have made to the St Barnabas Society since 6th April 2004, and all donations I make from the date of this declaration are to be treated as Gift Aid donations and I authorise the charity to reclaim tax on my donations. I undertake to notify the St Barnabas Society if I no longer pay an amount of Income tax or capital gains tax equal to the tax being reclaimed on my donations (28p for every £1 you give).
Signed:	Date:

Please return this form (cheques payable to the St Barnabas Society, please) to:

Fr. Robin Sanders
4 First Turn, Wolvercote
OXFORD
OX2 8AH

Telephone: 01865 513377

Registered with the Charity Commission No. 1009910
A Company Limited by guarantee
Registered in England No. 2645233