Apply for a disabled parking bay

Whenever possible, this application form should be completed by the Blue Badge holder. If this is not possible, it may be completed on their behalf, with the details being provided as though the Badge holder has completed the form themselves.

This form will take approximately 30 minutes to 1 hour to complete.
Please make sure you have enough time to complete the whole form in one session, so that your data is not lost.
You will need to attach the required evidence to this form by uploading it from the device you are using (computer, tablet).
The questions marked with an asterisk (*) are mandatory and require an answer.

Your data privacy

Before completing this form please read our general Privacy Policy (opens in a new window).

This explains why we ask for your data, what we do with it and how long we will keep it. It also explains how you can find out what data we hold about you and how you can ask us to delete it.

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Blue Badge holder details

Title

Select your title.

Other

Enter a title if it is not listed above.

First name *

Enter your first name.

Last name *

Enter your last name.

Middle name(s)

Enter any middle names separated by commas.

House name or number *

Enter your address name or number. This could a flat, house or building name or number.

Address line 1 *

Enter the first line of your address. This could be the street name.

Address line 2

Enter the second line of your address if you need to. This could be the village name.

Town or city *

Enter the town or city of your postal address.

Postcode *

Enter your postcode, with or without spaces.

Email address

Enter an email address where we can write to you.

Phone number *

Enter a daytime phone number that we can ring you on. This can be a mobile or land line number.

Alternative phone number

Enter another phone number we can reach you on. This can be a mobile or land line number.

Date of birth

Enter date of birth using numbers following the format day/month/year. For example, 01/01/1980 for 1 January 1980.

Type of property

Enter the type of property, such as flat or house.

Do you intend to move in the next 6 months? Select 'Yes' or 'No' as your answer. Yes No

Your Blue Badge

Full name on Blue Badge *

Enter the name on the Blue Badge.

Serial number *

Enter the serial number on the Blue Badge.

Expiry date *

Enter the expiry date on the Blue Badge using numbers following the format day/month/year. For example, 01/01/1980 for 1 January 1980.

Copy of your Blue Badge

Upload a photo or photocopy of your Blue Badge.

Complete our online form to request a disabled bay.

Your data privacy

Blue Badge holder details

Your Blue Badge

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