Gift Certificate Confirmation


The donor can claim the amount of his gift as tax deduction.

Donor

Company:
IČ:
DIČ:
Street:   number
City:
ZIP:

Contact person
Name:
Surname:
Phone:
E-mail:
Position in the company:
Name:
Surname:
Street:   number:
City:
Zip code:
Phone:
E-mail:

Recipient
 Život dětem, o.p.s.
Koclířova 771, 198 00 Praha 9 – Kyje
IČ: 70105031, DIČ: CZ70105031
Represented by: Anna Strnadova, chairman of the board

Information about the gift
Donated to following bank account:

Donor‘s account number:
Payment date:
Amount:
Amount by words:
Variable symbol:
Specific symbol:

Definition of the activity and purpose for which the gift is provided in accordance with the law:

This is a contribution to the Život dětem project, which helps seriously ill children in home care of their parents, children's departments of hospitals and care facilities for sick, disabled and abandoned children in the Czech Republic.

Recipient’s declaration:
The recipient confirms receiving the gift ……………………………………………………… , slovy: with the following statement:
He hereby agrees to use the funds received exclusively for the purposes for which they were provided, in accordance with the law. He acknowledges that the use of funds for a purpose other than that to which it they were provided implies unauthorized drawbacks contrary to the law and he is therefore obliged to return the funds to the donor.

Date ........................... Recipient’s signature:


..............................................................

I want to send confirmation
Mailing address
(Fill in if it differs from contact address.)
Street.:
City:
ZIP:

Note:


By submitting this request I agree with the processing of your personal data in accordance with the law and with the option of withdrawing your consent at any time. I agree with the processing of the aforementioned data by Život dětem o.p.s., for inclusion in the partner database, donor database and information on the organization's activities.