Disabled Parking Bay Application Form - Redditch Borough Council

1112SC0225Disabled Parking Leaflet:Layout 1 29/11/2012 11:11 Page 7Declaration (please tick).I confirm that I have read and understood the conditionson the information leafletI have enclosed a copy of my Blue Badge CertificateI have enclosed a copy of my Vehicle RegistrationCertificateI understand that the provision of false or misleadinginformation will delay the processing of this applicationand may lead to the application being refusedI will arrange for Redditch Borough Council to be informedshould the bay no longer be requiredIn the event of my moving home, I will inform RedditchBorough Council.Signed:........................................... Date:....................................Please print name: .......................................................................If you are completing this form on behalf of the Blue Badgeholder, please provide your name and address and relationshipto the Blue Badge holder: ......................................................................................................................................................................................................................................................................DisabledCar Parking BayApplication FormFor official use only:Comments from Tenancy ManagementRedditch Borough CouncilHousing Services, Town HallWalter Stranz SquareRedditch. B98 8AH