This document contains an eligibility declaration for VAT exemption on goods supplied to disabled people. The declaration states that the customer has a disabling condition and is receiving the MAGCELL® ARTHRO device from PhysioPod UK Limited for domestic or personal use, claiming relief from value added tax. The supplier signature confirms they are providing the MAGCELL® ARTHRO device to the person named in the declaration.

1. MAGCELL® ARTHRO – VAT EXEMPT DECLARATION
10. Eligibility declarations for goods and services for disabled people
10.1 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 have a disabling condition by reason of:
(and that)
· I am receiving from: PhysioPod UK Limited, 177 Sherbrook Road, Daybrook,
Nottingham, NG5 6AS
* the following goods which are being supplied to me for domestic or my personal use:
MAGCELL® ARTHRO and I claim relief from value added tax.
........................................................................................... (Signature)
................................................................................................... (Date)
Supplier PhysioPod UK Limited
I (full name) ..........................................................................................
of (address) 177 Sherbrook Road, Daybrook, Nottingham, NG5 6AS
am supplying to the person named above:
• the following goods: MAGCELL® ARTHRO
........................................................................................... (Signature)
................................................................................................... (Date)