ANPR Blue Badge registration form

Please use this form to register a blue badge for ANPR car parks.
Type of application
Please state
New applicationRenewalChange of vehicle
Badgeholder's details
Badgeholder's title
Badgeholder's name (or contact name if "organisational" blue badge)

First name

Last name
Address
Postcode
Telephone number
Email address
If badgeholder is under 18, please provide name of parent or guardian.

Badge details
Organisation name
Blue badge (disabled) number
Expiry date

Please enter as DD/MM/YYYY
Issued by
Upload copy of blue badge
If you are using wifi, we recommend you reduce files sizes before sending.
Upload scan of blue badge (front)

Please attach a scan of both sides of your blue badge.
Upload scan of blue badge (back)

Please attach a scan of both sides of your blue badge.

Vehicle details
I wish to register the following vehicle: only one vehicle for any blue badge. Only an “organisational” vehicle may be registered to an organisational Blue Badge. For further information please contact parking services.
Vehicle registration number
Vehicle make
Vehicle colour

Signature
I understand that I must comply with the terms and conditions for the use of a Blue Badge, and that any misuse may result in the issue of a Standard Charge Ticket and/or the concession being withdrawn. I enclose herewith a copy of both sides of my Blue Badge.
I accept the terms and conditions
Signed

Your privacy
We (Wycombe District Council) will collect and process some personal information as part of your application for an ANPR blue badge. We need to collect and process the information so that we can perform a task carried out in the public interest and in the exercise of our official authority: that is, processing your application for an ANPR blue badge registration. We will collect this information through a web form. We will not share any of the information collected with any other person or organisation. We ask for this information to help us deal with your application We ask for personal identifiable details (name, address and contact details, vehicle details, blue badge details) so that we can confirm your eligibility and contact you for further information, if required. Your information collected through the web form will be sent to the relevant council service by email. Your information will also be held within our web content management system (CMS) database for 31 days and then permanently deleted. The database is held in a secure UK based data centre leased by our CMS provider: Zengenti Ltd, Old Pump House, Cleedownton, Ludlow, SY8 3EG. Please also refer to our full data privacy statement.