Note to customer

You should complete this declaration if you are ‘chronically sick or disabled’ and the goods or services are for your own personal or domestic use. A family member or carer can complete this on your behalf if you wish.

A person is ‘chronically sick or disabled’ if he or she is a person:

• with a physical or mental impairment which has a long term and substantial adverse effect upon his or her ability to carry out everyday activities.
• with a condition which the medical profession treats as a chronic (persisting for a long time or constantly recurring) sickness.
• It does not include an elderly person who is not disabled or chronically sick or any person who is only temporarily disabled or incapacitated, such as with a broken limb.

If you are unsure, you should seek guidance from your GP or other medical professional.

This form will be kept with our VAT Records as evidence to the HMRC for 6 years.

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