I

declare that I am chronically disabled, and that the goods / services of adapting / services of repair that I am receiving from Brig-Ayd Controls as set out in

Invoice No are being supplied for my personal use. I claim that this supply of these goods/services are eligible for relief from Value Added Tax under Group 14 of schedule 5 to the Finance Act 1983 / Tax under Group 14 of schedule 4 to the Finance Act 1972