Eligibility declaration for goods and services for disabled people.

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 reliefs for disabled people or contact our National Advice Service on 0845 010 9000 before signing the declaration.

I ………………………………………………………………………………………………..

Of ………………………………………………………………………………………………

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

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

and that I am receiving from  Actual Mobility, Actual House, 21 Crown Street, Rochdale OL16 5LQ

The following goods which are being supplied to me for domestic or my personal use:

The following services to adapt goods to suit my condition:

The following services of installation, repair or maintenance of goods:

The following alterations to my private residence:

and I claim relief from value added tax.

................................................................. (Signature)              .......................... (Date)

I Neil Myers of Actual Mobility, Actual House 21 Crown Street, Rochdale OL16 5LQ

Is supplying to the person named above the following goods?

The following services of adapting goods:

The following services of installation, repair or maintenance of goods:

The following alterations to a private residence:

............................................................... (Signature)              ............................ (Date)