Isle of Wight Council

Application for Disabled Bay Waiting List

	Application form to be placed on the waiting list for the provision of a Disabled Bay on the highway.
	Highways And Transport County Hall Newport Isle of Wight PO30 1UD Phone Number � 01983 823777 Email address � [email protected] Fax number - 01983 823637

Your Details

	Title
*	Forename
	Middle name/Initials
*	Surname

*	Building/house name/number
*	Street address
*	Town name
	County
*	Postcode
	Contact telephone number (include area code)
	Email address
	Fax

Do you have a blue badge? In order to qualify for a disabled bay you or someone in the household must hold a current blue badge.

Yes No

Do you or anyone else own a vehicle at the address where the bay is required? In order to qualify for a disabled bay there must be a vehicle registered to the address where the bay is required.

Yes No

Do you have any off-street parking facilities? In order to qualify for a disabled bay, you must not have any off-street parking facilites, ie a driveway or garage. If you do then we may be able to offer you a free access protection bar.

Yes No

Is the address where the disabled bay is required your permanent residence? A disabled bay will only be provided at your permanent place of residence, for example not holiday homes.

Yes No

Is this a request for a new disabled bay or to have an existing disabled bay to be repainted ?

New Repainted

Please Note:

	* There is currently an approximate waiting period of six months. When your request comes near to    top of the list, you will be contacted directly and the relevant form will be sent out to you. * We will require a photocopy of the blue badge and the vehicle registration document. * The disabled bay provided is advisory only and does not provide the applicant to exclusive use.
	Engineering Services, Enterprise House, St Cross Business Park, Monks Brook, Newport, Isle of Wight PO30 5WB  Phone: 01983 823777 / Fax: 01983 520563 / Email: [email protected]

	Data Protection Act 1998
	This application may be monitored by the Isle of Wight Council for regulatory, quality control or crime detection purposes. Information from this application will be processed in accordance with the Data Protection Act 1998 for the purpose of processing your particular enquiry/request. The Isle of Wight Council ("the Council") is the data controller. By completing this form you consent to the Council contacting you by email or nominated contact method in relation to your enquiry/request. The information contained in this application may, in exceptional circumstances, be subject to disclosure to third parties under either the Data Protection Act 1998 or the Freedom of Information Act 2000 to the extent the law allows and in accordance with the Isle of Wight Council's Access to Information Policy. Disclosure will only be made where in all the circumstances it would be fair to do so and in the public interest. Please note that the Council may process your information in the absence of consent for the purpose of crime prevention or detection so far as is in accordance with the law.  Sometimes we may use your information to keep you informed about services, goods or relevant issues that we believe may be of interest to you. If you wish to receive this information for these purposes please tick this box To improve the quality of other services that we provide to you the Council wishes to hold your non-sensitive personal information on a secure central database. This will enable all Council services to use this information when they are providing a service to/for you. If you wish your non-sensitive personal information to be held by the Council please tick this box

Date printed: 07/03/2013