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I am a UK taxpayer. Please treat all donations I make or have made to Health Poverty Action for the past 4 years as Gift Aid donations until further notice. I am a UK taxpayer and understand that if I pay less Income Tax and/or Capital Gains tax than the amount of Gift Aid claimed on all my donations in that tax year, it is my responsibility to pay any difference. Please let us know if you want to cancel this declaration, change your name or home address or no longer pay sufficient tax.

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Health Poverty Action will send you a Direct Debit confirmation email within three working days of submitting your payment. If you are not the named account holder or require another signature to authorise Direct Debits on this account, please contact supporter care team on 020 7840 3765.

Direct debit service user number: 948643

Instruction to your bank or building society Please pay Health Poverty Action Direct Debits from the account detailed in this Instruction subject to the safeguards assured by the Direct Debit Guarantee. I understand that this Instruction may remain with Health Poverty Action and, if so, details will be passed electronically to my bank / building society.

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In order to set up an online Direct Debit you must be the account holder of a personal bank or building society account and the sole required signatory on the account. If you are not the only required signatory on your account, or you would rather send us a paper version of this form, download the printable PDF version of the Direct Debit form.

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