POSTAL ADDRESS ONLY: City of Cardiff Council, Blue Badge Team, Po Box 47, Cardiff, CF11 1QB. Please tick as appropriate: Renew New Replacement

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1 FORM BB1 AUTOMATIC APPLICATION FOR DISABLED PERSON S BLUE BADGE Apply online: POSTAL ADDRESS ONLY: City of Cardiff Council, Blue Badge Team, Po Box 47, Cardiff, CF11 1QB Telephone: (between 9.30am 12pm only) disabledbadges@cardiff.gov.uk Please tick as appropriate: Renew New Replacement RENEWALS ONLY Old badge number: Expiry date: PART A YOUR DETAILS Title: First Name: Surname: Surname at Birth: Town and Country of Birth: Address: Postcode: Tel: Mobile: National Insurance Number: Driving Licence Number: Previous Address (if previously applied): Date of Birth: Gender: FOR OFFICAL USE ONLY Computer No Approved Refused Date / / Payment Photos Evidence Manager 1

2 PART B IDENTITY 45 mm 35 mm Attach photo with name on reverse PHOTO A recent colour photo must be provided in accordance with passport standards. You can attach a passport sized photo to this application. CONFIRMATION OF ADDRESS: Photocopies only we will not take responsibility for original documents) Please supply a copy of one of the following as proof you live in the city. Utility bill Council tax bill Medical card Valid driving licence Whichever one you provide, it must be dated within the last 12 months. PART C AUTOMATIC ELIGIBILITY Please tick which of the following applies to you: 1 Are you registered as blind under the National YES NO Assistance Act 1948? (Partially sighted people do not qualify). If Yes, please provide your registration number 2 Do you receive the Higher Rate Mobility Component YES NO of the Disability Living Allowance? If YES, you must supply a photocopy of a letter of entitlement, see 7 below. 2

3 3 Do you receive 8 points or more for the Moving around YES NO component of Personal Independence Payment? If YES, you must supply a photocopy of a letter of entitlement showing how many points you receive, see 7 below. PLEASE NOTE: If your entitlement to the Higher Rate Mobility Component of the Disability Living Allowance or PIP is less than three years, your blue badge entitlement will match this period. 4 Do you receive 12 points for journey planning? YES NO If YES, you must supply a photocopy of a letter of entitlement showing how many points you receive, see 7 below. 5 Do you receive War Pensioners Mobility Supplement? YES NO If YES, please supply an official letter confirming this. 6 Can you provide a letter from The Service Personnel YES NO and Veteran s Agency confirming that you are in receipt of tariffs 1-8 under the Armed Forces and Reserve Forces Order 2011 and have been assessed as having a permanent substantial disability which causes inability to walk or very considerable difficulty in walking? If YES, please supply an official letter confirming this. 7 YOU MUST SUPPLY A PHOTOCOPY OF A LETTER OF ENTITLEMENT WITH YOUR CURRENT ADDRESS DATED WITHIN 12 MONTHS, STATING THE LENGTH AND TYPE OF ALLOWANCE COVERED. (ATTENDANCE ALLOWANCE DOES NOT QUALIFY). 3

4 PART D CHECKLIST Please check that you have completed all relevant parts of the form and have included the following items with your application form: Recent passport sized photograph attached to the form Proof of address and identity Signed declaration section Photocopy of evidence required dated within the last 12 months. If applying for a replacement because of loss, a 10 cheque or postal order made payable to Cardiff council. Failure to provide any of the above may result in a delay in processing the application. Reason for loss/replacement and crime number, if appropriate: Apply online: POSTAL ADDRESS ONLY: City of Cardiff Council, Blue Badge Team, Po Box 47, Cardiff, CF11 1QB Telephone: (between 9.30am 12pm only) disabledbadges@cardiff.gov.uk THIS FORM IS AVAILABLE IN WELSH 4

5 You must complete this section I confirm that: DECLARATION I will return my Blue Badge when it has expired or if I no longer need it. To the best of my knowledge, all the information I have provided is accurate. Print Name Signed Date FRAUD PREVENTION AND DATA PROTECTION This authority is under a duty to protect the public funds it administers and to this end, may use the information you have provided on this form for the prevention and detection of fraud. It may also share this information with other bodies for auditing or administering public funds for these purposes. For further information, see our Fair Processing otice Condensed Text at and the Fair Processing Full text on the Wales Audit Office website or contact C2C on or C2C@cardiff.gov.uk Data Protection Act 1998 Any data supplied by you on this form will be processed in accordance with the Data Protection Act requirements and in supplying it you consent to the Council processing the data for the purpose for it is supplied. All personal information provided will be treated in the strictest confidence and will only be used by the Council or disclosed by others for a purpose permitted by law. 5