Parking dispensation application form

Please complete all sections before submitting your application.

We have a duty to protect the public funds we administer and may use the information you have provided on this form to prevent and detect fraud. We may also share this information with other bodies responsible for auditing or administering public funds for these purposes.

For more information, go to www.dacorum.gov.uk/dataprotection.

Your details

Name

Forename(s)

House name or number

Street name

Town

Postcode

Daytime telephone number

Email address*

* Please ensure you include an email address as the parking team will need to send you a confirmation email with details on how to pay

Vehicle details

Registration

Make

For example, Renault, Vauxhall etc

Model

For example, Megane, Corsa etc

Colour

Dispensation details

Reason for dispensation

If the dispensation is for a skip, please state 'SKIP' as the reason.

Road and location

Please state the exact road and location - for example, "High Street Green outside house number XX"

Start date

For example, 12/09/2016

End date

For example, 13/09/2016

Start time

For example, 7.30am

End time

For example, 4.30pm

Type of bays and restriction

Please tick relevant box(es)

Residents permit bay
Pay and display bay
Shared use bay (residents permit, or visitors voucher, or pay and display ticket)
Single yellow line
Double yellow line
Limited wait bay

Payment

If your application is approved, we will send a confirmation email to you within five to seven days, with details on how to pay.

Declaration

I declare that all the information I have given in this application is correct and understand that a false statement or any breach of the above may result in the withdrawal of the dispensation and render me liable for prosecution.

By submitting this form, you are in agreement with our parking dispensation terms and conditions.

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