VAT EXEMPTION ELIGIBILITY DECLARATION:

I DECLARE THAT: I AM CHRONICALLY SICK OR HAVE A DISABLING CONDITION AND THAT I AM AN ELIGIBLE PERSON FOR ZERO RATED VAT UNDER GROUP 12 OF THE VAT ACT OF 1994 AND THUS AM ELIGIBLE FROM VALUE ADDED TAX OF THE BELOW GOODS OR SERVICES BEING TO ME (OR THE PERSON NAMED BELOW) FOR PERSONAL AND DOMESTIC USE ONLY. I AM RECEIVING FROM SIMPLYMED LTD, THESE GOODS WHICH ARE BEING SUPPLIED TO ME FOR DOMESTIC OR PERSONAL USE ONLY. 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 relief’s for disabled people or contact the National Advice Service on 0845 010 9000 before signing the declaration.