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

 

 

 

 (name)

(address)
 

 

Tel:

  
 
 
 
 
acting as the parent/guardian of (name)

(address)

 

age

  
 
 
 
 
who is chronically sick or disabled by reason of:  

 

 

 
declare that I am receiving for his/her domestic or personal use from:

Chariots All Terrain Pushchairs
Orchard Farm
Spreyton
Nr Crediton
Devon
EX17 5AS

VAT Reg. 750 7614 33
the following goods:  

 

 
and I claim relief from value added tax under Group 14 of Schedule 5 to the Value Added Tax Act 1983
 

(Signature)

  

(Date)