VAT Exemption Certificate

Patients with a chronic condition (which has lasted longer than 3 months)

are exempt from VAT on this product

I (name)

of (address)

Declare that I am chronically sick/disabled

(Description of illness)

and that I am purchasing from:-

Premier Medical Products

15 Prinknash Road

Putnoe

Bedford MK41 8DJ

The following goods which are being supplied to me for my personal use:

______________________________________

and claim that the supply of these goods is eligible for relief from VAT under Group 14 of the Zero Rated
Schedule to the VAT Act 1983. I declare that the equipment is being used under medical/physiotherapy supervision.

To be signed by

Doctor or Physiotherapist/Continence Advisor ___________________________________

Address      ___________________________________________

and Patient ________________________________________

Date            ________________________________________

If in doubt please consult your local VAT office