VAT Relief Form

Name*
I declare that*
 I am Chronically Sick or have a Disabling Condition by reason of 
 I am claiming on behalf of the below named who is Chronically Sick or has a Disabling Condition by reason of 
Medical Condition
Other
 and I am receiving goods from the allcare Ebay/Amazon Store for my domestic or personal use.  
Item purchased*
Name of person if you are claiming on behalf of someone