Dayga

Vat Exemption Form

VAT Exemption Eligibility Declaration
This forms completion is required for VAT exemption on Mobility products.

Please note there are penalties for making false declarations.

I (Full Name)*

Full Address*

Street Address
Address Line 2
City	State / Province / Region
Postal / Zip Code	Country

Declare that: I am chronically sick or have a
disabling condition by reason of: (give full and
specific description of your condition)*

and I claim relief from value added tax. (Please
re-enter your name)*

First

Last

Date (Please enter today's date)*

YYYY

Product Information: Please enter the Product you
are purchasing.*

I am receiving qualifying goods from T2
Enterprises Ltd for an eligible chronically sick
or disabled individual or for my domestic or
personal use.*

I confirm all the above information is correct

Image Verification
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