Full Name *

PPSN *

Email *

Street Address *

City *

State *

Country *

Eircode *

Phone *

Donation Amount *

€

Date of donation *

Confirmation that there is a relationship between yourself and Mellon Educate? *

Tax Relief *

By checking this box, I consent to Mellon Educate claiming tax relief on my donation under the Charitable Donation Scheme.

Irish Taxpayer *

I confirm that I am an Irish taxpayer, and that the amount donated was personally given and not on behalf of any third party. I understand that this allows Mellon Educate to collect my tax back and use it towards their charity cause.

By checking this box, I confirm that I am not an Irish taxpayer.

irish_taxpayer

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