How to complete the 2012

GIFT FORM …

National Capital Region (NCR) Government of

Canada Workplace Charitable Campaign

(GCWCC)

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OverviewPage 1 - Full GIFT FormPage 2 - OverviewPage 3 - Donor’s InformationPage 4 - Leadership GivingPage 5 - How to distribute your gift amongst United Ways

Page 6 - How to distribute your gift to United Way OttawaPage 7 - How to distribute your gift to United Way Ottawa (Cont’d)Page 8 - How to distribute your gift to Centraide OutaouaisPage 9 - How to distribute your gift to Centraide Outaouais (Cont’d)Page 10 - How to distribute your gift to any other United Way across Canada

Page 11 - How to distribute your gift to HealthpartnersPage 12 - How to distribute your gift to Healthpartners (Cont’d)Page 13 - How to distribute your gift to other Canadian Registered CharitiesPage 14 - Grand Total and Leadership GivingPage 15 - Method of PaymentPage 16 - Method of Payment by Payroll Deduction (Cont’d)

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Indicate appropriate form of Salutation (Mr., Ms., Mrs., Miss, Dr., Rank or other. ex. Reverend).

Include full name and home address (Canada Revenue Agency (CRA) requires that the address be completed for

income tax receipts).

Include the date (Year-Month-Date).

Include telephone number and home e-mail address (required for credit card donation) & desirable for thank

you/recognition.

Include your age range (not required, but useful for statistical purposes).

Important Note: The Canvasser Number & Organization must be filled by the respective canvasser.

Donor’s informationImportant-To be Filled by

the respective Canvasser

Important-To be Filled by

the respective Canvasser

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This section demonstrates an approximated cost of a donation after tax. For more information, please visit:http://www.cra-arc.gc.ca/chrts-gvng/dnrs/svngs/clmng1b2-eng.html

Be a Leader! Invest in the community…

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How to distribute your gift to the

United Ways

To designate your gift where it’s needed the most and will have the greatest impact amongst the United Ways, please proceed to the next page for instructions.

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How to designate your gift to

United Way Ottawa

To designate your gift to United Way Ottawa, you can choose between Option 1 and/or Option 2:

Option 1 (where it is needed most and will have the greatest impact):

Enter your gift amount in the top right corner of Box 1. Enter your gift amount in the bottom right corner of Box 1. If you are giving through payroll, divide your total by 26.

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How to designate your gift to

United Way Ottawa (Cont’d)

Option 2 (Direct donation to distribute your priority areas):

Enter your gift amount at the top right corner of Box 1 into one or more of United Way Ottawa’s priority areas. Enter your total gift amount in the bottom right corner of Box 1. If you are giving through payroll, divide your total by 26.

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To designate to Centraide Outaouais, you can choose between Option 1 and/ or Option 2:

Option 1 (Where it is needed most):

Enter your gift amount in the top right corner of Box 2. Enter your gift amount in the bottom right corner of Box 2. If you are giving through payroll, divide your total by 26.

How to designate your gift to

Centraide Outaouais

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Option 2 (Priority Areas):

Enter your gift amount into one or more of Centraide Outaouais’ priority areas.Enter your total gift amount at the bottom right corner of Box 2. If you are giving through payroll, divide your total by 26.

How to distribute your gift to

Centraide Outaouais (Cont’d)

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To designate your gift to any other United Way across Canada, follow the instructions below.

Enter the name of the United Way you would like your gift to be designated to. Enter your gift amount in the top right corner of Box 3. Enter the appropriate identification # / United Way Code on the bottom left corner of Box 3. (You may find the 5 digit numbers behind the GCWCC 2012 calendar or by visiting our website: http://www.gcwcc-ccmtgc.org/en. Enter your total gift amount in the bottom right corner of Box 3. If you are giving through the payroll, divide your total by 26.

Note: If you choose to designate your gift to more than one United Way across Canada, it is necessary to list the name(s), your gift amount, identification #/United Way code on a blank sheet of paper and attach to the gift form ; donor’s name and signature is required on the additional sheet of paper.

How to distribute your gift to any other United Way

across Canada

Important

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How to distribute your gift to Healthpartners

To designate your gift to Healthpartners, you can choose between Option 1 and/or Option 2:

Option 1

You may choose to divide your gift equally to the 16 Healthpartners organizations by entering your gift amount in the top left corner of Box 4. Enter your gift amount in the bottom right corner of Box 4. If you are giving through payroll, divide your total by 26.

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How to distribute your gift to Heathpartners (Cont’d)

Option 2 (Designate to one, or more organizations of Healthpartners):

Enter your gift amount at the top left corner of Box 4 into one or more organizations of Healthpartners/Partenairesanté . Enter your total gift amount at the bottom right corner of Box 4. If you are giving through payroll, divide your total by 26.

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To designate your gift to one or more of the 85,000 + Canadian Registered Charities of your choice, follow the instructions below:

Note: A minimum $26 gift per charity is required in order for the GCWCC to honor the gift.

Please indicate the exact name of the charity (This is important because many charities have similar names).

The charity must be registered with the Canada Revenue Agency and you must indicate the BN/Registration number. This number

may be obtained by visiting the CRA’s website: http://www.cra-arc.gc.ca/charities or by calling 613-954-0410.

Enter your gift amount for each charity.

Note: If you choose to designate your gift to more than four Canadian Registered Charities , it is necessary to list the charities with

the exact names and the appropriate BN/Registration number of charity on a blank sheet of paper and attach to the gift

form; donor’s name and signature is required on the additional sheet of paper.

Enter your total gift amount in the bottom right corner of the Box 5.

If you are giving through payroll, divide your total by 26.

How to distribute your gift to other Canadian

Registered Charities Important

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Grand Total and Leadership Giving

Total GiftPlease verify that the amounts reported in boxes 1,2,3,4 and 5 are correct and the total is the sum of all of these boxes.

For Leadership Gifts Only (gifts of $ 1,000 +)The names of Leadership Givers are included in an annual thank-you document unless otherwise indicated. If you give at this level, you can choose not to have your name included in the document and either still receive information on events or not.

Important

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In this section you may select several options for your method of payment, follow the instructions below:

Please check the appropriate box (Payroll Deduction/Cash/Cheque/Post-Dated Cheque(s)/Credit Card). Enter the total of your gift amount in the appropriate box. Payroll Deductions : Proceed to the next page for instructions. Cash: Submit your gift form and money to your canvasser. Cheque: Make cheque payable to “United Way GCWCC ”. Attach the cheque to the gift form. Post-Dated Cheque(s): Make post-dated cheque(s) payable to “United Way GCWCC ”. Attach the post-dated cheque(s) to the gift form. Credit Card: - Indicate the type of credit card (Visa, Master Card or American Express). - Include the card number and expiration date. - If the expiration date will occur in the following year, please call 613-683-3795 to give your new card number and expiration date. - Please sign the signature line (If the name of the person appearing on the credit card is different, please print the name on the signature line). - You must choose between the twelve (12) monthly payments or one time (1) payment. Note: If you choose the twelve (12) payments, the payment will be taken on the 15 th of each month, starting in January. If you choose the one time (1) payment, it will be processed once it is received and verified at United Way Ottawa. - Enter your gift amount in the respective box. For other giving options (life insurance, stocks or bequests), please call 1-877-379-6070. Please submit your gift form to your canvasser!

Method of payment

Enter you full name. Enter your Payroll Office #, Department Code, Pay List # and your PRI #. This information should appear on your Pay Stub, if not, please consult

your Payroll Office. Indicate how you distributed your payroll Gift. Verify that the amounts reported at the top of the gift form are an accurate

reflection of the designated amounts reported in boxes 1 , 2 , 3 ,4 and 5 are correct and total is the sum of all boxes. In other words, the gift form must balance!

If you gave to any other United Way other than Ottawa or Outaouais, please indicate the United Way code under Box 3 above. Payroll Deductions: Indicate how much you wish to distribute your gift per pay period (there are 26 pay periods). Ensure that the amount of the

donation can be divided into the number of pay periods (for example: $1,000.22 / 26 pays = $38.47 per pay). Please sign and enter the date.

Note: Donors making a gift through payroll deduction must not detach this section. It will be detached and forwarded to your payroll office by your Campaign Treasurer.

Please submit your gift form to your canvasser!

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Payroll DeductionsImportant

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