Pledge Form Name * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Mobile Number * Email * Total Pledge Amount £5000 (Inner Tile) £1500 (Outer Tile) £500 (Musalla’) Other Other Amount Frequency * Weekly Monthly Immediate Gift Aid Opt In * I am a UK taxpayer and would like PICC to reclaim tax on all donations I have made within the last four years and all donations that I make hereafter. Yes, I would like to add Gift Aid Continue without adding Gift Aid Jazak Allah Khayr