| Go-active leisure ltd
Unit F
Dutch Nursery
West Street
Coggeshall Essex
CO6 1NT
Phone 01376 561312
www.goactivemobility.co.uk
Email: sales@goactivemobility.co.uk
freephone : 0800 334 5140
VAT Registration Number UK GB 853 6994 73
Customer: Please sign and post back to us this form
If you are in any doubt as to whether you are eligible to receive goods or services zero-rated for VAT you should consult Customs & Excise Notice 701/7 ‘VAT reliefs for disabled people’ or contact the C&E National Advice Service on 0845 010 9000 before signing this declaration
I (full name) …………………………………………………………………………………………………….
Of (address) ……………………..…………………………………………………………………………….
………….. ………………………………………………………………………………………………………
Post Code……………………………… Telephone No………………….…………………………….
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 Go-active leisure of the above address, the following goods which are being supplied to me for domestic or my personal use:
(Description of goods)…………………………………………….…………………………………
………………………. …………………………………………………..………………………….
And I claim relief from value added tax.
……..………………….……………………………………………………………………………. (Signature)
…………………….……………………………………………………………………………………… (Date)
N.B. There are severe penalties for making false declarations
Supplier
We, Go-active leisure ltd, Unit F,Dutch Nursery, West Street,Coggeshall Essex,CO6 1NT
Are supplying to the person named above the following goods;
……………………………………………….……………………………………………………………….
………………………………..………………………………………………………………………………
For the personal use of the disabled person.
………..……..……………………………………………………………………………………. (Signature)
………..………………………………………………………………………………………………… (Date) | 
Basket
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