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VAT Exemption Form

Goods and Services for Disabled Persons: Eligibility Declaration by an Individual

I (full name)  ___________________________________________________

Of (address) _________________________________________________________________

Declaration that I am chronically sick or disabled by reason of:


(Give full and specific description of your condition)


and that I am receiving from: Numark Pharmacy, Field St Shepshed,Leics,LE12 9AL                           ____________________________________________________________                       

the following goods which are being supplied to me for domestic or my personal use:


(enter description of goods)


and I claim relief from value added tax under Group 14 of Schedule 5 to the Value Added Tax Act 1983.

Signature: ________________________________________

Date: ___________________________________________

Note to Supplier

You must keep this declaration for production to your VAT office. The production of this Certificate does not automatically authorise the zero-rating of the supply. You must also ensure that the goods and services you are supplying qualify for zero-rating.

Note to 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 your local VAT office before signing the declaration.

 Warning: section 39.2 of the VAT Act 1983 provides for severe penalties for anyone who makes use of a document which they know to be false for the purpose of obtaining VAT relief.

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Numark pharmacy is a UK online pharmacy registered with the General Pharmaceutical Council. We hope you will find this website useful, but it’s not intended to replace professional medical advice. Any information given on this site may not necessarily be current or take your own individual health situation into account. Therefore you should make sure that you carefully read the information leaflet and label on any product you buy from us before use.

If you have, or suspect you may have a health problem you should consult your doctor.  Numark pharmacy  is not responsible or liable for any diagnosis made by a user based on the content of the Numark Pharmacy website.