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Customer Declaration
 
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 our National Advise Service on 0845 010 9000 before signing the declaration.
 
I (Full Name)……………………………………………..
Address ( as above)
Declare that:
  • I am chronically sick or have a disabling condition by reason of : (give full and specific description of your condition);
  • …………………………………………………………………………………………………………………… and that
  • I am receiving from East Anglian Mobility Warehouse.
  • the following goods which are being supplied to me for domestic or my personal use:
    (description of goods)…………………………………………………………………………………………………
  • the following services to adapt goods to suit my condition:
    (description of services and goods) ……………………………………………………………………………………
  • the following services of installation, repair or maintenance of goods:
    (description of services and goods)……………………………………………………………………………………
  • the following alterations to my private residence:
    (description of alteration)……………………………………………………………………………………
  • the services of monitoring a personal alarm call system.
And I claim relief from value added tax
………………………………………………………(signature)
………………………………………………………(date)