VAT Exemption Form
Goods and Services for Disabled Persons: Eligibility Declaration by an
Individual
I
(full name)
___________________________________________________
Of
(address) _________________________________________________________________
Declaration
that I am chronically sick or disabled by reason of:
_____________________________________________________________________
(Give full and specific
description of your condition)
______________________________________________________________
and
that I am receiving from: Numark Pharmacy, Field St Shepshed,Leics,LE12 9AL ____________________________________________________________
the
following goods which are being supplied to me for domestic or my personal use:
____________________________________________________
(enter description of goods)
______________________________________________________________
and
I claim relief from value added tax under Group 14 of Schedule 5 to the Value
Added Tax Act 1983.
Signature:
________________________________________
Date:
___________________________________________
Note
to Supplier
You
must keep this declaration for production to your VAT office. The production of
this Certificate does not automatically authorise the zero-rating of the
supply. You must also ensure that the goods and services you are supplying
qualify for zero-rating.
Note
to Customer.If you are in any doubt as to whether you are eligible to receive
goods or services zero-rated for VAT you should consult your local VAT office
before signing the declaration.
Warning:
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 purpose of
obtaining VAT relief.
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