Your donation

Donation: monthly    Amount: £3

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Tick to Gift Aid. I confirm that I am a UK Income or Capital Gains taxpayer. I have read this statement and want Brake to reclaim tax on my donation, given on the date shown. I understand that if I pay less Income Tax and / or Capital Gains Tax in the current tax year than the amount of Gift Aid claimed on all of my donations, it is my responsibility to pay any difference. I understand the charity will reclaim 25p of tax on every £1 that I have given.

Reasons for giving

Please tell us the name of your loved one
Please give brief details of your activity. For example: 'I took part in a sponsored walk during Road Safety Week' or 'Our school ran a Bake for Brake cake sale as part of Brake's Kids Walk'

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Donation: Monthly    Amount: £3

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