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Please print this form, complete it, and return it to the Membership secretary


(This replaces the former Deed of Covenant Scheme and applies to UK Income Tax payers only)


The Dvořák Society of Great Britain (Registered Charity No. 267336)


Mr. Mrs. Miss. Ms. etc

First Name(s)






Post Code:

I want the Dvořák Society of Great Britain to treat all subscriptions and donations I make from the date of this declaration until I notify you otherwise as Gift Aid Donations.




  1. For this declaration to be valid you must pay an amount of income tax and/or capital gains tax at least equal to the tax that the Society reclaims on your donations in the tax year.
  2. 2 Pease advise the Society if your Name or Address changes while this declaration is in force.
  3. If you pay tax at the higher rate you can claim further tax relief in your Self-Assessment tax return.
  4. You can cancel this declaration at any time. Notify the Society and it will then not apply to donations you make on or after the date of cancellation, or such later date as you specify. For example you would cancel this declaration if in the future your circumstances changed and you no longer paid tax on your income and capital gains equal to the tax that the Society reclaims.
  5. If you are unsure whether your donations qualify for Gift Aid tax relief, ask the Membership Secretary, or you can ask your local tax office for leaflet IR113 Gift Aid.

N.B. If this covenant is accompanied by a Banker’s Order it aids efficient administration.

The Dvořák Society web pages are edited by Dvořák Society member Ray Latham (
Last modified 6th January 2005