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Tax Cercate
Your Address:
Lump sum payment to a charity established in Jersey
Your full name:
Have made a single payment to:
The net sum of:
Your Signature
I
Tax reference of donor:
Of
Name of charity:
£
and that all the condions below have been sased.
Date:
Condions:
The donor:
is resident in Jersey for tax purposes on the date
the payment is made
has paid, or will pay, income tax at least
equivalent to the tax in respect of the gi (the
details of the donaon should be included on the
tax return)
on
Company name:
Capacity:
Complete the boxes below if the form has been signed on behalf of a company.
The payment:
is made in money and is not subject to a
condion that any part of it can be repaid
is not due under a deed of covenant
is not part of an arrangement to benet the
donor, the donor’s family or an individual or
company connected to the donor
is not linked to the acquision of property by the
charity except by way of a gi
is at least £50 and when added to other lump
sum donaons by the donor or persons
connected with the donor, does not total more
than £500,000 in any one calendar year.
This form needs to be sent to the charity’s administrator when the donaon is made.
For Charity’s use
Charity tax reference:
Taxes Oce use
R10(LSD)
(amount in words)
Tax Certificate Template
source: gov.je
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