VAT Exemption Purchase Form

VAT Exemption Purchase Form

For Hearing Aid Accessories
Eligibility Declaration By Disabled Person For Zero Rated VAT Supply.

(Note: disabled in this instance means having a confirmed hearing loss)
I,*

First NameLast Name
Of address,*

Address Line 1

Address Line 2

CityCounty

Post Code
Email*
Declare that:
1. I have an eligible disabling condition by reason of hearing impairment, and
2. I am receiving from Crystal Hearing Ltd the following goods which are being supplied to me for domestic / my personal use to assist my disabling condition (in other words - not solely for business use or bought by a business).
Item 1:*
List product here
Item 2:
List second product here if applicable
Item 3:
List third product here if applicable
And I declare that I am eligible to claim VAT relief due to a hearing loss disabling condition that has been assessed following a proper hearing test by an Audiologist or Hearing Aid Dispenser, and that if requested by HMRC I can submit a copy of my hearing test results or give details of where / who we can obtain a copy of the results.
What hearing aids do you have? - make and model
Leave blank if unknown
Any other comments:
i.e. signing on behalf of someone else
Note: this form is easier to sign using a tablet or mobile phone
Signed:*

Clear
Date:
Please verify that you are human*
Please note there are heavy penalties for making false declarations to avoid paying VAT.

This form in simple terms - if you are UK resident, are buying personally (not via a business) and are UK resident - sign it.

If you are in any doubt as to whether you are eligible to receive goods or services zero-rated for VAT you should consult Notice 701/7 VAT reliefs for disabled people or contact the HMRC National Advice Service on 0300 200 3700 before signing this declaration.
Contact Us

More information on VAT relief
Crystal Hearing Limited - VAT number 982 1129 25
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