Zero-Rated VAT Eligibility Declaration
Name
Address
I Declare That I Am:
Receiving goods for personal use
Suffering a disabling condition
Chronically sick
Adapting goods to suit my condition
Having repair/maintenance of goods
Specific Description of Your Condition
Date In The Form MM/DD/YYYY
Your Phone Number Without Spaces
E-Mail
Supplier
MOUNTSIDE MOBILITY 68 HAZEL AVENUE GUILDFORD SURREY GU1 1NT VAT Registration no. 936 6222 17
Exemption Declaration
By entering your details above and sending this form, you are declaring your eligibility to receive goods or services ZERO-rated for VAT. 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 the National Advice Service on 0845 010 9000 before sending this declaration. PLASE NOTE THERE ARE PENALTIES FOR MAKING FALSE DECLARATIONS Re-type your name below as your signature to this form
Electronic Signature (Enter Full Name)