Harmony Medical
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Eligibility declaration by a disabled person  

Please note there are penalties for making false declarations  

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 Notice 701/7 VAT reliefs for disabled people or contact the National Advice Service on 0845 010 9000 before signing the declaration.

I (full name) ..............................................................................

of (address) ..............................................................................

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

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: (name and address of supplier) the following goods which are being supplied to me for domestic or my personal use: (description of goods)

 

and I claim relief from value added tax.

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

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

 

PLEASE COMPLETE FORM, Sign and date

Return to the form to:

Harmony Medical Distribution Limited 629 High Road Leytonstone, London E11 4PA, GB.

You must attached this form with your order, together with your remittance, to address above. We DO NOT accept back-date declaration nor refund VAT if you failed to compile

 

You can download the pdf

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