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Application for a Disabled Person's Parking Bay

Applicant's Name
Title
Address
Do you have a blue badge?
Blue badge details
Is a car registered at this address?
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?
Do you have another location where off road parking is available?
Applicable
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.
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.
 
Signed
Title
If different from the applicant.

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

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