Declaration For Relief From VAT

If you are wish to claim VAT relief, please complete this declaration and return it with your order form and payment, by post or by fax. Items marked '*' in the catalogue are NOT eligible for VAT relief.

I am chronically sick or disabled (as defined below) and I am receiving from Clarks Independence Centre the goods on the attached order form, whic are for my personal or domestic use. I claim that the supply of these goods is eligible for relief from VAT under the VAT Act 1994.

Insert details of your chronic sickness or disability below. Note: there are severe penalties for making a false declaration.

Sickness/Disability:

Signed

Date