VAT EXEMPTION FORM
---------------------------------------------

You will not have to pay VAT if the following 3 conditions are applicable:
· You declare that you (or the person for whom you are purchasing the
products on behalf of) are chronically sick or disabled*
· The products that you are purchasing are eligible to be supplied at a
zero rate of VAT.
· The products that you are purchasing are being supplied to you (or the
person for whom you are purchasing the products on behalf of) for
domestic or personal use only.
· You (or the person for whom you are purchasing the products on behalf
of) do not have to be registered disabled, but the nature of the illness or
disablement must be specified below.

VAT DECLARATION
---------------------------------------------

For you (or the person for whom you are purchasing the products on behalf of)
 qualify for VAT relief you must complete the section below.

I (Full name of the person who will use the products)...........................................

Of (Address): …………….............................................................................

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

           ........................................Post Code: ..................................


I declare that I am chronically sick or disabled because I have (please be specific):


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

I am receiving products which are to be used for domestic or my personal use.
I claim relief from Value Added Tax under Group 12 of Schedule 8 to the
Value Added Tax Act 1994.

Signature (if applying for yourself)............................................................

Signature (if applying on behalf of someone else)...............................................

Date.............................................

By completing this form you authorise for this information to hold your
information on file. This data will be used for VAT accounting purposes only.