I (full name):

of (address):

Declare that:

I am receiving from Online Medical Products LTD, Field House, Gardenfield, Higham Ferrers, Northants, NN10 8LP the following items which are being supplied for my personal use and I claim relief from value added tax.

Please add the part numbers of the items you wish to order below:
Details of chronic illness/disability:

Signature (type full name)

Online Medical Products LTD complies with its obligations under the Data Protection Act 1998. By completing the VAT relief certificate) you consent to Online Medical Products LTD recording and sharing the information provided only for the purposes of fulfilling this agreement.

Once your details have been checked by our team, we will contact you by one of the details you provide below:

Phone number: Email: