Deed of Covenant

Form of covenant by an individual for use in England and Wales

Please print and complete this form.

To: The John Charnley Trust (Registered Charity no 326395)
 

Notes

I promise to pay you for ………. years, or during my lifetime, if shorter, such a sum as after deduction of income tax at the basic rate amounts to

1

£…………….

2

each month / quarter / year

3

from [the date shown below] …………………………………………………………………..

4

Signed and delivered …………………………………………………………………………..

5

Date …………………………………………………………………………………………….

  

Full name ………………………………………………………………………………………

  

Address …………………………………………………………………………………………

  

………………………………………………………………………………………………….

  

………………………………………………………………………………………………….

  

Witnessed by (signed) …………………………………………………………………………

  

Full name ………………………………………………………………………………………

  

Address …………………………………………………………………………………………

  

………………………………………………………………………………………………….

  

………………………………………………………………………………………………….

  

Notes

  1. Enter the period of the covenant, which must be longer than three years. In practice charitable covenants should be written to last a minimum of four years.

  2. Enter the amount you will be paying to The John Charnley Trust.

  3. Delete as appropriate to show how often you will make the payment.

  4. Delete as appropriate. If you choose to enter an actual date it must not be earlier than the date you sign the deed.

  5. You must sign the form and enter the date you actually sign it in the presence of the witness, who should also sign where shown.

Return with completed bankers standing order and form R185(covenant) to the Secretaries, McMillan & Co, Manor House, Carr Lane, Croston, PRESTON, PR5 7RE.