Legacy payments

PDSA Staff ID

Deceased's Details

Title *

Forename *

Surname *

Postcode

Find Address

Address Line 1

Address Line 2

Address Line 3

Town

County

Country *

Day

Month

Year

Day

Month

Year

I would like to make a legacy payment of *

Are you an executor of the will? *

Yes

What is their relationship to you? *

Is this gift is for a fixed amount? *

Yes

Please state the share of the estate

Please confirm if the gift was *

part of the will

a verbal request on their behalf

Other (please state in addition notes)

Additional notes