I Declare that I am chronically sick or have a disabling condition by reason of (give full description below of your condition) and, that I am receiving from Adret Gibs Ltd: Drinkup Hands-free Drinking System, Drinkup variations, accessories, spare parts and/or Consumable Parts Pack(s), which are being supplied to me for my personal use. And, I claim relief from VAT. (Please complete all sections below).