PAYROLL GIVING DONATION FORM

Payroll Giving Give As You Earn Donation Form

Increase your Donation by Tax Relief

If you choose to donate more than €250 a year or €21 a month through your payroll your donations can have a double impact. By sending a completed CHY2 Cert to the relevant charity they can claim tax relief.

You donate	€10	€21	€250
Cost to you as a 20% or 41% tax payer	€10.00	€21.00	€250.0
Charitable Giving administration	5%	5%	5%
Charity receives (20% taxpayer)	€9.50	€25.00	€300.0
Charity receives (41% taxpayer)	€9.50	€34.00	€411.0

Source code: PGA [Sustain]

Please select donation type
This is a first time donation
This donation supersedes any previous donation given
Add this donation to my existing donations

How often are you paid?
Please select your payment frequency : Monthly 4 Weekly Fortnightly Weekly

I would like to give from my pay to:

Charity Name : Amount : €

+ More Charities

Charity Name : Amount : €
Charity Name : Amount : €
Charity Name : Amount : €

Total amount to be deducted from your NET pay each pay day: € 0.00

DECLARATION: By signing this form you are confirming your understanding that only gifts to eligible charities and approved bodies within the Republic of Ireland can be accepted and that no gift can be made as a membership subscription or to pay for goods or services supplied.
Title:
First name:
Last name:
Email address:
Confirm e-mail address:
Telephone number:
Mobile number:

Your home address

Address line 1:
Address line 2:
Town / city:
County:

Your employment details

Employer's full name :

Employee/staff number:

(Normally found on payslip)

Personal Public Service Number (PPS No)

Work address line 1:
Work address line 2:
Work town / city:
Work county:

Your digital signature
Enter your full name as confirmation of the completed form:
No part of your donation is taken by us in commission. We are paid a fee from the charity based on results.
Please Note: You should allow up to 6 weeks before the donation will show on your pay slip. The time delay depends on when your payroll department receives the form relative to the cut-off date for each payroll run.

Data protection
The data supplied on this form will be used to enable your donations to reach your chosen charity/ies. In order that your instructions can be acted on, your details will be passed to the registered agency, with whom your employer is contracted, who will forward your donation to your chosen charity/ies. Your chosen charity/ies may send you a thank you letter acknowledging your donation.
Please tick here if you do not wish to receive updates and communications from your chosen charity about how your support is being used, or about special projects, events or appeals.
Please tick here if you do not wish your name to be given to any other charitable organisations whose mission the above charities feel may be of interest to you.

Form security information
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Time/date stamp:	24 Oct 2017 02:32:01
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