THIS FORM NEEDS TO BE RETURNED PRIOR TO WORKS STARTING

Office Use
Invoice No:
Invoice Date:
Form No:

Value Added Tax Act 1983 –

Group 14 of the Zero Rated Schedule

PLEASE COMPLETE IN BLOCK CAPITALS

I (full name)	{0}
Of (address)	{1}

Declare that I am chronically sick or disabled,
and that I am receiving from (name and address of supplier or builder):

POLLOCK LIFTS

Unit 1 Sloefield Drive, Trooperslane Ind Est, Carrickfergus
Co. Antrim, N. Ireland, BT38 8GX.

The following alterations to my private residence (description of alterations):


	Lift Installation

And claim that the supply of these goods or services is eligible for relief from
Value Added Tax under Group 14 of the Zero Rated Schedule of the Value Added
Tax Act 1983.

Signed:

{2}