VAT Exemption Form

Eligibility declaration by a disabled person

Please note there are penalties for making false declarations

If you are in any doubt as to whether you are eligible to receive goods or services zero-rated for VAT you should consult Notice 701/7 Vat relief's for disabled people or Contact the National Advice Service on 0845 010 9000 before making the declaration.

I (Full Name)

Of (Address)

Declare that I am chronically sick or have a disabling condition reason of

(Please give a full and specific description of your condition);

and that; I am receiving from Mobility Outlet, I can claim relief from Value Added Tax under Group 12 of Schedule 8 to the Value Added Tax Act 1994. The following goods which are being supplied to me for my domestic and/or personal use.

Enter your full name here to confirm declaration:

Today's Date:

Email Address:

Telephone: