Zero-Rating Eligibility Declaration

This declaration may be signed by the dyslexia sufferer or his or her parent, guardian, doctor or other responsible person. It authorises us not to charge VAT on the sale of (PRODUCT NAME).............................................................

It should only be signed if the signatory is satisfied that dyslexia has a long term adverse effect on the sufferer’s liability to carry out normal day-to-day activities, including reading, writing, remembering and studying.

If you need further information, please contact the HM Customs and Excise National Advice Service on 0845-010-9000.

Please note there are penalties for making false declarations.

I (NAME)................................................... of (ADDRESS) ......................................... ............................................................... declare that (NAME OF DYSLEXIA SUFFERER) ................................. .................................. of (ADDRESS) ..................................................... ........................................................ has a disabling condition by reason of dyslexia and that I am receiving the following goods which are being supplied to me for my domestic or personal use:

(DESCRIPTION OF GOODS)

.........................................................................................................

.........................................................................................................

and I claim relief from VAT.

……………………………………………………. Signature

……………………………………………………… Date

We are supplying to the person named above the following goods:

(DESCRIPTION OF GOODS).....................................................................................

.......................................................................................................................................

for the personal use of that person.

………………………………………………………… Signature

………………………………………………………… Date

For help or advice regarding this form please contact us.