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of a Blue Badge, and that any misuse may result in the issue of a Standard Charge Ticket and/or the concession being withdrawn.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