Confidential Pledge

If you intend to leave a legacy to Viva!, it will help us enormously to know what it is so that we can plan more accurately for the future. This pledge is simply a declaration of your current intentions, has no legal implications and is in no way binding!

My gift to Viva! is in the form of:

[  ] the entire residue of my Estate
[  ] part of the residue of my Estate
[  ] a percentage of my Estate
[  ] a cash gift (pecuniary legacy) of £______
[  ] a non-money specific gift of the following asset(s)
__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

[  ] I have now included Viva! in my Will
[  ] I have not yet included Viva! in my Will, or made a Will, but intend to do so

Title: _________ First Name: _____________________ Surname: ________________________

Address: _________________________________________________________________________

________________________________________________________________________________

____________________________Postcode: _________________Tel ________________________

Signature ______________________________

Date __________________________________

Email _________________________________

Juliet Gellatley, Founder & Director, VVF, Top Suite, 8 York Court, Wilder Street, Bristol BS2 8QH.

Or email it to juliet@viva.org.uk

Many thanks.