Northern Ireland Chest Heart & Stroke
Regular Giving Form
To set up your regular gift simply complete the form below. It won’t take long and will mean so much to the thousands of people we provide services to.

Please choose donation frequency:


Please fill in your personal details:

Fields marked with an asterix (*) are required.


First Name:*






Contact number:*


Your support saves lives and helps people devasated by chest, heart and stroke conditions. We'd loved to keep in touch about our work and how your donations are helping. Your details will only be used by NICHS. We will never give your information to other organisations to use for their own purposes. You are free to change your mind at any time by contacting our Supporter Care Team on 028 9026 6709. Please read our Privacy Policy for more information.

We really value your support and would like to find out a little bit more about you. Please take this opportunity to tell us more about your reasons for supporting us by ticking all relevant boxes below.

I am interested in the following areas of NICHS’s work:

Service User’s Number: 861281

Your Bank Account Details:

Sort Code:*

Account Number:*

Name(s) of Acc. Holder(s):*

Name & Address of your Bank/Building Society:*

Instruction to your Bank or Building Society

Please pay Northern Ireland Chest Heart & Stroke Direct Debits from the account detailed on this instruction subject to the safeguards assured by the Direct Debit Guarantee. I understand that this instruction may remain with Northern Ireland Chest Heart & Stroke and if so, details will be passed electronically to my bank/building society.

The Direct Debit Guarantee

direct-debit-smallThis Guarantee is offered by all Banks and Building Societies that take part in the Direct Debit Scheme. The efficiency and security of the Scheme is monitored and protected by your own Bank or Building Society.

If the amounts to be paid or the payment dates change NICHS will notify you 10 working days in advance of your account being debited or as otherwise agreed.

If an error is made by NICHS or your Bank or Building Society, you are guaranteed a full and immediate refund from your branch of the amount paid.

You can cancel a Direct Debit at any time by simply contacting your bank or building society. Written confirmation may be required. Please also notify us.

Boost your donation by 25p of Gift Aid for every £1 you donate

The Government's Gift Aid scheme allows us to receive an additional 25p for every £1 you give to NICHS - at no extra cost to you. We will reclaim 25p of tax for every £1 you give. All you need to do is to tick the box below.

*I am a UK taxpayer and understand that if I pay less Income Tax and/or Capital Gains Tax in the current year than the amount of Gift Aid claimed on all my donations it is my responsibility to pay any difference.

If, in the future, you want to cancel your Declaration, change your name or address, or no longer pay sufficient tax on your income and/or Capital Gains, please contact Supporter Care on

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