Blue Badge Application Form

This online application form should only be completed by customers who meet the automatic qualifying Criteria for a Blue Badge.

If you do not meet the automatic criteria you may still qualify for a Blue Badge. The application form can be downloaded from the website.

Please complete all relevant sections of the application form and attach the appropriate documents to confirm your address, identity and evidence of eligibility.

The local authority may refuse to issue a badge if you do not provide adequate evidence that you meet the eligibility criteria.

Please note mandatory fields are marked with an *

1. Information about the applicant

If you are completing the form on behalf of an applicant who is under 16 or who is unable to complete the form themselves, please provide their details in appropriate sections and sign the form on their behalf.

If you are applying on behalf of an organisation that cares for and transports disabled people then please do not complete Section 1. You only need to complete Sections 3 and 4.

Title: *

First Names: *

(in full)

Surname: *

Surname at birth: *

Gender: *

Date of birth:

Place of Birth

Town: *

Country: *

National Insurance Number / Child Registration Number: *

Driving Licence Number:

(If you hold a driving licence)

Current Address and Contact details

Address 1: *

Address 2:

Town / City: *

County: *

Postcode: *

Home Telephone: *

Mobile:

Email:

Previous Address and Contact details

Address 1:

Address 2:

Town / City:

County:

Postcode:

Previous or Current Blue Badges

Do you currently hold a Blue Badge, or have you held a Blue Badge before ?: *

If YES, please complete the following

Which local authority issued you with the last badge ?:

What is the serial number on the last badge ?:

What is the expiry date of the last badge ?:

Proof of address

We need to check that you are a resident in this local authority area before we can process your application. Please select one of the following options and attach documentation where relevant.

I give consent to the local authority to check my personal details on the local authority's Council Tax Database so that I do not need to submit proof of my address.

I have enclosed a Council Tax Bill bearing my name and address, dated within the last 12 months

I do not pay Council Tax, am over the age of 16 and give consent to the local authority to check my address on the electoral register.

I am applying on behalf of an applicant who does not pay Council Tax and is under the age of 16. I give my consent to the local authority to check school records to confirm their address.

Please attach proof of your address:

If appropriate, please attach proof of your address (e.g. scanned Council Tax bill)

Proof of identity

We need to check your identity to reduce the potential for fraudulent applications for a Blue Badge. You must attach a copy of one of the following as proof of your identity.

Birth or Adoption Certificate

Marriage or Divorce Certificate

Passport

Civil Partnership or dissolution Certificate

Valid Driving Licence

Please attach proof of your identity:

Photograph

Please attach one recent passport-style photograph of the applicant. The photograph needs to show the applicant’s full face so that the holder can be easily identified. No one else should be in the photograph. The photograph will be placed on the back of the badge and will not be visible when the badge is being displayed in the vehicle.

Please ensure that you complete Section 4(a) and 4(d) of this form to confirm that the photograph is a true likeness.

Please attach a recent passport style photograph: *

Badge Issue Fee

There is a charge of £20 for all successful Blue Badge applications.

Payment will be taken for all online applications for a Blue Badge. If your application is unsuccessful any payment made will be refunded.

Vehicle Registration Numbers

Please nominate the vehicle registration number(s) for the main cars in which you intend to use the Blue Badge.
(Up to Three registration numbers should be nominated, but please remember that other vehicles can be used)

Vehicle Registration:

Section 2 - Questions for applicants

These questions are intended for people who may qualify for a Blue Badge automatically because they:

are severely sight impaired (blind);
receive the Higher Rate of the Mobility Component of Disability Living Allowance;
receive the War Pensioner’s Mobility Supplement; or
receive a qualifying award under the Armed Forces and Reserve Forces (Compensation) Scheme.

2a) People who are severely slight impaired (blind)

This section is for people who are severely slight impaired (blind) [Regulation 4(2)(c)]

Are you registered as blind (severely sight impaired)?:

If YES, please state the local authority you are registered with:

If NO, then please indicate whether you have attached a copy of your Certification of Blindness or Defective Vision (BP1 (3R)) or Certificate of Vision Impairment (CVI) or a previous equivalent, signed by a Consultant Ophthalmologist.:

Please attach a copy of your Certificate of Vision impairment (CVI) or a BD8 form below

Please attach a copy of your certificate (if appropriate):

2b) People who receive Higher Rate Mobility Allowance

This section is for people who receive the Higher Rate of the Mobility Component of Disability Living Allowance [Regulation 4(2)(a)]

Do you receive the Higher Rate of the Mobility Component of Disability Living Allowance?:

If Yes, have you been awarded this benefit indefinintely

Yes

If NO, when is your award of this benefit due to end?:

If you are in receipt of the Higher Rate of the Mobility Component of Disability Living Allowance you must attach a copy of your letter of entitlement to this benefit issued within the last twelve months or your original annual uprating letter. Please attach a copy of the letter of entitlement below

Please note that we may also check that you are in receipt of this award with the Department for Work and Pensions.

Please attach a copy of your letter of entitlement (if appropriate):

2c) People who receive War Pensioner's Mobility Supplement

This section is for people who receive the War Pensioner’s Mobility Supplement [Regulation 4(2)(d)]

Do you receive the War pensioner's Mobility Supplement?:

If Yes, have you been awarded this benefit indefinintely?

Yes

If NO, when is your award of this benefit due to end?:

If you are in receipt of the War Pensioner’s Mobility Supplement please attach your letter of entitlement to this benefit. You should have an award letter from the Service Personnel and Veterans Agency (SPVA). Please attach a copy of your letter below. If you have lost this letter, then the agency can be contacted via the free-phone enquiry number: 0800 169 22 77.

Please attach a copy of your award letter or letter of entitlement (if appropriate):

2d) People who receive Armed Forces and Reserve Forces (Compensation) Scheme

This section is for people who receive a benefit under the Armed Forces and Reserve Forces (Compensation) Scheme [Regulation 4(2)(d)(d)]

Have you received a lump sum benefit under the Armed Forces and Reserve Forces (Compensation) Scheme within tariff levels 1 – 8 (inclusive) and have been certified by the SPVA as having a permanent and substantial disability which causes inability to walk or very considerable difficulty walking?

Have you received a Lump Sum Benefit:

Please attach a copy of your letter of award or entitlement (if appropriate):

If you are in receipt of the above mentioned award under the Armed Forces and Reserve Forces (Compensation) Scheme, the Service Personnel and Veterans Agency (SPVA) will have issued you with a letter confirming the level of your award and also confirming that you have been assessed as having a permanent and substantial disability which causes inability to walk or very considerable difficulty in walking. You must attach a copy of this letter as proof of entitlement below. If you have lost this letter, then the agency can be contacted via the free-phone enquiry number: 0800 169 22 77.

Section 3 - Applying for an Organisational Blue Badge [Regulation 5]

These questions are intended for organisations involved in the care of disabled people who are seeking a Blue Badge for a vehicle/vehicles (e.g. minibus, or specially adapted commercial vehicle) which is/are to be used to carry disabled people who would themselves qualify for an individual Blue Badge. Please see Section 6 of the accompanying guidance note for a list of the eligibility criteria prescribed in the regulations that govern the scheme.

An ‘organisation’ is defined in legislation as meaning an organisation concerned with the care of disabled persons to which a disabled person’s badge may be issued.

Organisational badges will therefore only be issued to an organisation which:

Cares for and transports disabled people who would meet one or more of the eligibility criteria for a individual Blue Badge; and
Has a clear need for an organisational badge rather than using the individual Blue Badges of people it is transporting.

Organisational badges should only be used when transporting disabled people in their care who meet one or more of the eligibility criteria for a badge – and must not be used for the employee’s benefit when they are carrying out other business on behalf of the organisation. It is unlikely that taxi or private hire operators and community transport operators would be eligible for an organisational Blue Badge as they are not usually concerned with the care of disabled people who would meet one or more of the eligibility criteria for a badge.

Name of Organisation:

Main Contact Name:

Address

Address 1:

Address 2:

Town / City:

County:

Postcode:

Telephone:

Email:

Does your organisation care for disabled people who would themselves qualify for an individual Blue Badge?

Yes

If YES, please give details of the nature of this care:

As part of that care, does your organisation provide them with transportation?

Yes

If YES, please give details of the types of vehicles in which you wish to use the badge, their vehicle registration number and how often they are used to transport disabled people:

Transport Vehicles

Transport Vehicles Details

Type of Vehicle:

Vehicle Registration Number: