Application for a Disabled Person's Parking Bay

Title

First name

Surname

Address

Address 2

Town

Postal Code

Telephone number

Email address

Do you have a blue badge?

Yes

Blue badge details

Serial number

Date of issue

Expiry date

Is a car registered at this address?

Yes

Please provide registration number of vehicle

Please upload a copy of vehicle registration document V5

One file only.
8 MB limit.
Allowed types: gif, jpg, jpeg, png, pdf, doc, docx.

Do you have a driveway/vehicular access at this address?

Yes

Do you have another location where off road parking is available?

Yes

What are the reasons for your parking difficulty?

Please indicate within this description, the distance from your home which you normally have to park and if there are times when it is particularly difficult e.g. evenings.

Where do you suggest a disabled person's parking bay could be located?

Please upload a simple location sketch

One file only.
8 MB limit.
Allowed types: gif, jpg, jpeg, png, pdf, doc, docx, ppt, pptx, xls, xlsx.

I declare to the best of my belief all the statements I have made on this form are true and I agree to the Local Authority contacting other Agencies when necessary for the purpose of obtaining information to support my application.
I understand that the parking place is not for my exclusive use and can be used by anyone displaying a Blue Badge.
N.B. If signing on behalf of the applicant, please provide a contact number if different from that of the applicant.

Title

First name

Surname

Contact number

If different from the applicant.

Based on your answer you are not eligible for a disabled person's parking bay.

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