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 our 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: Phoenix Walking Stick Co Ltd

* the following goods which are being supplied to me for domestic or my personal use:
(Walking stick(s))

and I claim relief from value added tax.

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

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