GOODS AND SERVICES FOR DISABLED PERSONS: ELIGIBILITY - DECLARATION BY AN INDIVIDUAL

Client Name*

Full name of the user of the equipment being purchased

Client Address*

Full address of the user of the equipment being purchased

Declare that I am chronically sick or disabled by reason of:*

Please give a full and specific description of the condition

I am receiving from Wealden Rehab Ltd, 113 Hopewell Drive, Chatham, Kent, ME5 7NP the following goods which are being supplied to me for domestic of my personal use:*

Confirm the description of goods being purchased

Form registered by*

Name of the person completing this form

Your email address*

Tick box to confirm

I hereby confirm that I claim VAT relief under Group 14 of Schedule 5*

NOTE TO CUSTOMER

If you are in any doubt as to whether you are eligible to receive goods and services zero-rated for VAT, you should consult your local VAT office before submitting the declaration. Section 39.2 of the VAT Act 1983 provides for severe penalties for anyone who makes use of a document which they know to be false for the purposes of obtaining VAT relief.

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