VAT Form

One Stop Mobility™
+44 (0) 1932 35 38 39

I am chronically sick or disabled by reason of: (give full and specific description of your condition)_______________________________________________________________________

and I am receiving from One Stop Mobility the goods detailed below, which are being supplied for my personal or domestic use. I claim that the supply of these goods is eligible for relief from VAT under group 12 of Shedule 8 to the Value Added Tax Act 1994.

Note: If you are in any doubt as to your eligibility to receive goods or services zero-rated for VAT you should consult your local VAT office before signing the declaration.

Signature of user of goods.................................................

Date................................

Name and Address of User of Goods on this order form - please print in block capitals.