Disabled Parking Permit

Transcription

1 CASEY.VIC.GOV.AU Disabled Parking Permit Hw can I apply? Individuals T apply fr an individual permit yu must cmplete the applicatin frm with a dctr (a medical practitiner, specialist medical practitiner r clinical psychlgist). Please g t page 3 t cmplete yur applicatin fr an individual permit. Organisatins T apply fr an rganisatin permit, yu must prvide a cver letter, which addresses the fllwing:» why des yur rganisatin require the permit/s» if mre than 10 permits are required, why des yur rganisatin need the additinal permits. Please g t page 5 t cmplete yur applicatin fr an rganisatin permit. Hw d I submit? Yu can submit via , pst r in persn. By caseycc@casey.vic.gv.au By pst: Custmer Service City f Casey PO Bx 1000 Narre Warren VIC 3805 What happens next? In persn:» Civic Centre, Narre Warren Magid Drive, Narre Warren 8 am 6 pm Mnday t Friday.» Custmer Service Centre, Cranburne Cranburne Park Shpping Centre 9 am 5 pm Mnday t Friday. 9 am 12 pm Saturday.» Custmer Service Centre, Narre Warren Suth Amberly Park Shpping Centre 9 am 5 pm Mnday t Friday. 9 am 12 pm Saturday. Offices nt pen n public hlidays If successful, yur permit will be psted within 10 business days. If yu submit in persn, the permit will be issued immediately. Where can I find mre infrmatin? Visit the City f Casey website at casey.vic.gv.au r cntact a Custmer Service Officer n

2 2 Hw d I use my permit? Categries f Permit Cnditins f use: Ensure yur permit has nt expired. Display yur permit n the left side f the frnt windscreen s the expiry date and permit number is visible and legible frm utside f the vehicle. Ensure the permit hlder is driving r is a passenger f the vehicle displaying the permit. Individuals may nly hld ne permit. Organisatins may hld several permits. The permit applies Australia-wide. If yu are stpped by an Authrised Officer, yu may be asked t: state yur name and address prduce yur driver's licence prduce yur valid disabled parking permit shw prf that the permit hlder is present in the vehicle If the Authrised Officer deems that yur permit is invalid, r that there is insufficient prf the permit hlder is present, yu will be asked t mve the vehicle frm the reserved place. The permit remains the prperty f the City f Casey and must be returned within seven days if yu are requested t return it. Cuncil des nt issue renewal ntices. It is yur respnsibility t cntact yur lcal Cuncil when a new permit is required. Page 2

3 3 1. Disabled Parking Permit Individual Permit Applicatin Only cmplete this sectin if yu are applying fr an individual permit. Fr rganisatin permits, g t page 5. Applicant details Fields marked with an asterisk(*) are mandatry and must be cmpleted. Given name/s:* Surname:* Street address:* Pstcde:* Date f birth (DD/MM/YY):* Telephne:* Mbile: The next sectin must be cmpleted by a dctr (medical practitiner, specialist medical practitiner r clinical psychlgist). Medical practitiner details Practice name:* Practice pstal address:* Pstcde:* Practitiner s name:* Telephne:* Office Use Only Extra time nly P X2 A / B / D EXP: / / Page 3

4 4 Medical infrmatin This sectin must be cmpleted by a dctr (medical practitiner, specialist medical practitiner r clinical psychlgist). Fields marked with an asterisk(*) are mandatry and must be cmpleted. 1. Des the Applicant have ne r mre f the fllwing:*» an acute r chrnic illness in which minimal walking may endanger their health» a significant ambulatry disability requiring a cmplex walking aid (with mre than ne cntact pint n the grund)» presents an extreme danger t themselves r thers in a public place withut cntinuus attendance f a caregiver? Yes (g t Questin 2) N (g t Questin 1a) 1a. Des the Applicant have a significant ambulatry disability r severe illness which impacts their ability t walk lng distances withut rest breaks? Yes N 2. Is the Applicant s cnditin a permanent, life-lng disability?* Yes (g t Questin 3) N (g t Questin 2a) 2a. Fr hw lng des the Applicant require a permit? 6 mnths 12 mnths 5 years 3. Is the Applicant able t drive? * Select Yes if the Applicant is presently unable t drive, but will be able t drive again in the future. Yes N Medical practitiner declaratin By ldging this applicatin, I firmly declare that all infrmatin n this frm is, t the best f my knwledge, true and crrect. I am aware false declaratins may be punishable by law. Name & Address f Medical Practitiner, Specialist r Clinical Psychlgist (Please use fficial stamp t verify) Signature: Date: Privacy statement: Yur persnal infrmatin will be handled in accrdance with the Privacy and Data Prtectin Act 2014 and used fr the specified purpse. Yu can access yur persnal infrmatin by cntacting Cuncil s Privacy Officer n Page 4

5 5 2. Disabled Parking Permit Organisatin Permit Applicatin Only cmplete this sectin if yu are applying fr an rganisatin permit. Fields marked with an asterisk(*) are mandatry and must be cmpleted. Organisatin details Organisatin name:* Street address:* Pstcde:* Given name/s:* Telephne:* Mbile: * Number f permits Please indicate the number f permits required:* Organisatin cver letter T supprt yur applicatin, yu must prvide a cver letter that addresses the fllwing:» why des yur rganisatin require the permit/s» if mre than 10 permits are required, why are the additinal permits required. Submit Please submit this applicatin and yur cver letter t Cuncil t prcess yur permit. Office Use Only Extra time nly P X2 C EXP: / / Page 5