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Your help makes all the difference so please help us to keep changing lives for the better
The
difference
your
support
makes
It helps us change lives for the better,
because with it we can invest in the latest
and best medical equipment for our
dedicated medical staff.
We can support pioneering research into
preventing, treating and curing complex
heart and lung diseases in the future
and we can make the hospital a more
welcoming and comfortable environment
for our patients and their families.
The difference
you have already
made
Supporting the first robotic heart and
lung surgery programme in the UK
Helping us provide family
accommodation so they can be near
their loved ones during treatment
Providing a beautiful outdoor garden
for our patients and families next to the
Critical Care Unit
Developing our 3D heart project so
that patients can better understand
their condition.
I would like to make a single donation
£5 £10 £50 £100 Other
Please make cheques payable to:
Liverpool Heart and Chest Hospital Charity.
Please only use this box if you wish to make a regular gift:
I would like to make a regular donation
£5 £10 £50 £100 Other
I would like payment to be taken from my account
on the 1st or 16th of each month starting on
DD MM Year
Account to be debited
Bank Name
Bank Address
Sort Code
Name(s) of account holder(s)
Account Number
Our Bank details
Bank
Address
Account Name
BArclays bank
48B to 50 Lord Street, Liverpool L2 1TD
Sort Code 2 0 5 1 4 3
LIVERPOOL HEART AND CHEST HOSPITAL CHARITY
Account Number 1 0 1 4 7 7 4 5
Keep a copy for your records
The funds you have donated will be used for the purposes you have indicated. If for any
unforeseen reason we are unable to complete your request or there are surplus funds,
we will use the donations for the benefit of the Liverpool Heart and Chest Hospital.
Your Details (please print)
Title
First Name
Surname
Email (please print)
I give you permission to email me (please tick box) about this donation
with information about LHCH charity and its work.
Address
Postcode
Tel No:
I give you permission to call me (please tick box) about this donation
with information about LHCH charity and its work.
I would like to support the work of:
If you would like to support a particular area of the hospital’s work then
please say so here.
Gift Aid it and make more
of your donation
I want to Gift Aid my donation of £______________
and any donations I make in the future or have made
in the past 4 years to the Liverpool Heart and Chest
Hospital Charity.
PLEASE TICK ONE BOX ONLY
I am a UK tax payer and understand that if I pay less
Income Tax or Capital Gains Tax in the current tax year
than the amount of Gift Aid claimed on all my donations
it is my responsibility to pay any difference
or
I am NOT a UK taxpayer
Signature
Date
Please return this form to:
Liverpool Heart and Chest Hospital
Charity, Freepost RRLL-KSHT-ZLKE,
Thomas Drive, Liverpool L14 3PE
LHCH Charity values your privacy and we never share your details with outside
organisations. Your information will only be used to fulfill your request and keep
you up to date with our activities. If you would prefer not to receive any further
communications from LHCH Charity please tick this box For a complete statement
of our Privacy Policy and how we use your data please visit www.lhchcharity.org.uk