VAT Exemption Certificate
Full name of eligible person
Please enter the full name of the person who will be using the EMS Physio medical device
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Address
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Town
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County
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Postcode
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By completing this form you are declaring that you are an eligible person under paragraph 1 of VAT Leaflet 701/7/86 and that you are a person with a disability, illness or disease that requires the use of the EMS Physio Medical Device that you wish to purchase
Please enter a description of your disease, illness or disability below.
The clinically diagnosed name will suffice - further detail is not required e.g. Osteoarthritis
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You will be receiving goods from EMS Physio Ltd, Grove Technology Park, Downsview Road, Wantage, Oxfordshire, OX12 9FE. Please complete the details of the goods which you require for your personal or domestic use.
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By completing this form you are claiming that the supply of these goods or services is eligible for relief from value added tax under Group 14 of the Zero Rate Schedule to the Value Added Tax Act 1983
Please enter your name below to confirm this statement
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Please select todays date
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There are penalties for making a false declaration. If you are in any doubt about your own eligibility or the goods or services you are buying, you should get advice from any local VAT office before completing this declaration.
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