declare that the goods I shall purchase from Autogen Bioclear UK Ltd will be used directly by us solely for the purpose of medical research or diagnosis.

These goods will be bought from funds provided entirely by a charity or from voluntary contributions.

I claim that the supply of these goods is eligible for relief from Value Added Tax under Group 15 of Schedule 8 of the Value Added Tax Act 1994

Authorised Signatory ……………  (type name)

Date ……17 / 5 / 2008

Note: There are severe penalties for making a false declaration. If you are in any doubt about the eligibility of the goods that you are buying, you should seek advice from any local VAT office before signing this declaration.