Mr/Mrs/Miss/Ms ___________Initials _______________ Surname_____________________________________
Home Address ________________________________ ____________________________________________
___________________ Postcode _________________
Phone._________________
E mail _______________________________________

I will support AVI's partners with a donation of
£10___ £25___ £50 ___£100___ Other ____

Please specify which programme you wish to support or leave blank to allow us to allocate your donation where there is greatest need:
_____________________________________________

I enclose a cheque made payable to Action Village India
OR

Please debit my:
MasterCard __Visa Delta__ Visa Electron__ CAF Charity Card __
Card no:

Expiry date: _______ Start date: _______ Signature_____________________________ For donations by credit card, please supply a daytime telephone number to confirm payment.

Gift Aid Declaration If you are a taxpayer we can make your membership and donations worth 25% more by reclaiming tax that you have already paid them. I want AVI to treat the enclosed donation of £____as a Gift Aid donation and agree that all donations I make from the date of this declaration until I notify you otherwise, as Gift Aid donations.   Signature_____________________________ Date __________ You must pay an amount of Income Tax and/or Capital Gains Tax at least equal to the tax that the charity reclaims on your donations in the appropriate tax year (currently 25p for each £1 you give).

Please return to: AVI, 76 Wentworth Street, London E1 7SA

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