Blue Badge Application Form – Individuals
(AS27)
To be completed for all applicants.
Badges will only be issued to people who either pay their
council tax to Dudley MBC or receive council tax benefit from
Dudley MBC. If you pay council tax to, or receive council tax
benefit from, a local authority other than Dudley MBC, you will
need to contact the Blue Badge Team within your own council
Please read the accompanying guidance notes before completing all
relevant sections. PLEASE NOTE that the appropriate documents (listed
within the guidance notes) to confirm your address, identity and evidence
of eligibility will need to be brought in to the office ONCE your application
has been processed – these documents should not be returned with your
application form. Photographs will not be required as a digital image will
be taken if your application is successful.
If you do not complete the application form in full this could result in your
application being delayed.
We may refuse to issue a badge if you do not provide adequate evidence
that you meet the eligibility criteria.
The fee for a blue badge is £10.00. Payment can be made by *credit/debit
card (Brierley Hill only), cash or cheque and will only be taken if your
application is successful. You will only be supplied with a blue badge
once payment has been received.
* denotes a charge of 1.2% when payment is made with a credit card.
Information provided by:
Role/relationship to applicant:
1. Information about the applicant
Name:
Mr/Mrs/Miss/Ms:
Name at birth (if different):
Date of birth:
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Address (proof of this will be required later – see guidance notes):
Previous address (if moved in the past three years):
Town of birth:
Telephone number:
Gender:
National insurance/child registration number:
NHS number:
Please provide further details (including names, addresses and contact numbers)
for professionals who have been treating you:
2. Ethnic origin
Asian/Asian British
– Bangladeshi
Black/Black British
– African
Gypsy/Roma
Mixed White &
Black Caribbean
White – Other
Cultural
Background
Asian/Asian British
– Indian
Black/Black British
– Caribbean
Mixed – Other
Mixed Background
Traveller of Irish
Heritage
Any Other Ethnic
Group
Asian/Asian British
– Other Asian
Black/Black British
– Other Black
Mixed – White &
Asian
White British
Asian/Asian British
– Pakistani
Chinese
Mixed White &
Black African
White Irish
Any Other Ethnic
Group – Arab
3. Type of application
New applicant
Renewal
Replacement (lost/stolen)
If the application is a renewal, please provide further details below:
Issuing local authority:
Serial number of current badge:
Expiry date of current badge:
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4. Entitlements/registrations
These questions are intended for people who may qualify for a Blue Badge
automatically because they: are severely sight impaired (blind); receive the
Higher Rate of the Mobility Component of Disability Living Allowance; receive
the appropriate component of Personal Independence Payment; receive the War
Pensioner’s Mobility Supplement; receive a qualifying award under the Armed
Forces and Reserve Forces (Compensation) Scheme. You will be required to
provide evidence if you are able to answer yes to any of the questions in this
section.
If you are unsure whether these questions apply to you, then please consult
section 4 of the guidance notes enclosed with this application form. Please note
that people in receipt of the Care Component of Disability Living Allowance
alone, or Attendance Allowance, do not qualify automatically for a Blue
Badge
4a. People who are severely sight impaired (blind)
Please answer yes or no to the following questions:
Are you registered as severely sight impaired (blind)?
If YES, please state which local
authority you are registered with:
If YES, do you give consent to us to check the local authority’s
register of severely sight impaired people to see whether your
disability is already known to the council?
If NO, then please indicate whether you have a copy of your
certificate of vision impairment (CVI) or BD8 form, signed by a
consultant ophthalmologist stating that you wish to be registered
as blind
Yes
No
4b. People who receive the Higher Rate of the Mobility
Component of Disability Living Allowance
Do you receive the Higher Rate of the Mobility Component of
Disability Living Allowance?
If yes, have you been awarded this benefit indefinitely?
If not, when is your award of this
benefit due to end (DD/MM/YY)?
4c. People who meet a “Moving Around” descriptor for the
Mobility Component of Personal Independence Payment (PIP)
Does your “Moving Around” descriptor for the Mobility Component meet/match
any of the following statements?
You can stand and then move unaided for more than 20 metres
but no more than 50 metres (8 points)
You can stand and then move using an aid or appliance for more
than 20 metres but no more than 50 metres (10 points)
You can stand and then move for more than 1 metre but no more
than 20 metres (12 points)
You cannot stand or move for more than 1 metre (12 points)
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If you have answered yes to any statement in section 4c, have you
been awarded this benefit indefinitely?
If not, when is your award of this
benefit due to end (DD/MM/YY)?
4d. People who receive the War Pensioner’s Mobility
Supplement
Do you receive the War Pensioner’s Mobility Supplement?
If yes, have you been awarded this benefit indefinitely?
If not, when is your award of this
benefit due to end (DD/MM/YY)?
4e. People who receive a benefit under the Armed Forces and
Reserve Forces (Compensation) Scheme
Have you received a lump sum benefit under the Armed Forces
and Reserve Forces (Compensation) Scheme within tariff levels 1
– 8 (inclusive) and been certified by the SPVA as having a
permanent and substantial disability which causes inability to walk
or very considerable difficulty walking?
If you answer “yes” to any question in section 4 then you will qualify for a
blue badge without any further assessment, although proof of
entitlement/registration will be required once your application has been
processed; more information regarding proof can be found in the
accompanying guidance notes. Please proceed to section 12 of the
application form. If you do not answer “yes” to any of the questions in
section 4 then please continue to section 5 of the form.
5. Medical conditions/disabilities
Please provide details of any medical conditions or disabilities which affect your
walking ability:
Condition
Date
diagnosed
Current treatment or
surgery eg hip replacement
Date of surgery
6. Medication
What medication (including pain relief) do you currently take in relation to the
conditions described above?
Medication
Dosage
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7. Mobility
Please tick the statements that best describe your ability to walk:
I am able to walk well, including recreational walks
I am able to walk around the supermarket to do my own shopping
I am able to walk, but struggle with longer distances or hills
I am able to walk, but get breathless if I walk for more than a few minutes
I am able to walk, but find it too painful to walk for more than a few minutes
I am able to walk but use a wheelchair for longer trips outside the home
I am able to walk around my home, but am unable to climb the stairs
I walk with a heavy limp, a stiff leg, I shuffle or have problems with balance
Whilst walking I drag my leg, stagger, swing through two crutches or need
physical support
I am unable to walk at all
What (if any) mobility aids do you use?
Are these aids used:
Are you able to walk outside without help?
Indoors
Yes
If not, what do you use?
Walking stick(s)
One
Zimmer frame
Yes
Wheelchair
Yes
Crutches
One
Physical assistance
Yes
Please use this space if you wish to describe the way you walk:
Outdoors
No
Two
No
No
Two
No
8. Distance (see guidance notes for examples)
How far would you estimate you are able to walk without stopping? (If you are
unsure as to how far you are able to walk without stopping, please refer to
section 8 of the attached guidance notes, which provides local examples)
Metres:
Yards/feet:
Roughly how much time would you estimate it takes you to walk this distance?
Minutes:
Please answer yes or no to the following questions:
Yes
No
Are you troubled by shortness of breath when hurrying on level
ground or walking up a slight hill?
Do you get short of breath walking around with other people of
your own age on level ground?
Do you have to stop for breath when walking at your own pace
on level ground?
Are you able to continue walking after a short rest?
If yes, roughly how long (in minutes) are you able to walk for in total?
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Do you get too breathless to leave your home?
Do you experience pain or discomfort when walking?
How would you describe this pain/discomfort?
Please rate the highest level of pain you experience on the line below, where 0 =
no pain and 10 = extreme pain:
0
1
2
3
4
5
6
7
8
9
10
Is this: at rest
during walking
after walking
Please use this space to describe any effects on you which are caused by
walking:
9. Treatment/surgery
Are you currently…
(Please tick all that apply, and provide further details in the space below)
Awaiting surgery in relation to the conditions described in section 5?
Recuperating from surgery in relation to the conditions described in
section 5 above?
Awaiting treatment for any of the conditions described in section 5
above?
Managing your condition/disability since you have been advised that it
is not expected to improve any further?
Please provide further details, including names, addresses and contact numbers
for healthcare professionals who have been treating you:
10. Applicants with a disability in both arms
Please answer yes or no to the following questions:
Yes
No
Do you drive regularly?
Do you have a severe disability in both arms?
Are you unable to operate, or do you have considerable difficulty
operating a parking meter or pay and display machine due to
your upper limb disability?
If yes, please describe the difficulties you have with operating parking meters and
pay and display machines
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Do you drive a specially adapted vehicle?
If yes, please describe how the vehicle has been adapted for you, and enclose a
copy of your insurance details verifying this adaptation
11. Children under 3 years old
To be used for all ‘subject to further assessment’ applicants under the age of 3.
PLEASE NOTE that applications on behalf of children must include
supporting medical information such as a letter from the child’s paediatric
consultant explaining how their condition impacts upon their mobility.
11a. Medical equipment
Please answer yes or no to the following questions:
Yes
No
Are you applying on behalf of a child under the age of three who
has a condition requiring transportation of bulky medical
equipment at all times?
If YES, please state what the child’s medical condition is, and which type of
equipment is required:
11b. Quick access to transport
Are you applying on behalf of a child under the age of three who
suffers from a condition which requires that they must be always
kept near a motor vehicle so that they can, if necessary, be
treated for that condition in the vehicle or be taken quickly in the
vehicle to a place where they can be treated?
If YES, please describe the child’s medical condition.
12. Further information (optional – ALL)
Is there anything else you can add that you think is relevant in support of your
application for a Blue Badge?
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Section 13. Declarations and signatures
These questions are intended to be answered by all applicants for a Blue Badge
13a. Mandatory declarations about the information you have
provided and the application process
Please read
the following
declarations.
Please tick
each one in
the white box
provided to
indicate that
you have
read,
understand
and agree
with each
declaration.
Not ticking
one of these
declarations
may mean
that we are
unable to
issue you
with a Blue
Badge.
I confirm that, as far as I know, the details I have
provided are complete and accurate. I realise that you
may take action against me if I have provided false
information in this application form.
I confirm that I do not currently hold a Blue Disabled
Person’s Parking Badge that has been issued by a
different local authority.
I understand that I must promptly inform my local issuing
authority of any changes that may affect my entitlement
to a badge.
I confirm that I pay my Council Tax to Dudley MBC
I understand that you will deal with all documents relating
to this application in line with the Data Protection Act
1998, and you may share them with other local
authorities, the police and parking enforcement officers
to detect and prevent fraud.
I understand that the medical information I have supplied
to support this application is deemed to be “sensitive
personal data” and I consent to its disclosure only to a
third party who is responsible for the operation and
administration of the Blue Badge scheme and other
Government Departments or agencies, to validate proof
of entitlement.
I agree to the local authority contacting an accredited
healthcare professional if necessary, for the purpose of
obtaining further information in support of my application.
I agree that, if my application is successful, I will not
allow any other person to use the badge for their benefit
and I agree that I will use the badge in accordance with
the rules of the scheme as set out in the “Blue Badge
scheme: rights and responsibilities” leaflet which will be
sent to me with the badge.
13b. Optional declaration/consent:
I consent to the local authority checking any information
already held by the Council’s Social Care department on
the basis that:
 It can help determine my eligibility for a Blue
Badge
 It may speed up the processing of my application
 It may enable a decision to be made without the
need for a mobility assessment
13c. Your signature against the declarations in section 12:
Your signature:
Date of application:
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Please print your name
here:
14. Collection of your blue badge
Should your application be successful, you can either opt to have your badge sent
to your home address or you can collect it from one of our offices. Please select
one of the options below:
I wish to have my blue badge sent to my
home address
I wish to collect my badge from:
Brierley Hill Health and Social Care Centre
Venture Way
Brierley Hill
DY5 1RE
I wish to collect my badge from:
Dudley Library
St James’s Road
Dudley
DY1 1HR
15. FOR OFFICE USE ONLY
Date of application/date of assessment
Applicant PIN
ID/address proof seen (type of document)
Document
Dated
AIS input
BBIS input
Payment made
Receipt number
FOR STAFF USE ONLY
Please attach applicant’s previous badge (if appropriate) here
with the photograph side uppermost
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Verified by
Blue Badge Application Form - Guidance Notes for
Individuals
Please read through these guidance notes and ensure that you have the
appropriate documentation to prove your identity and address before
completing the application form.
The fee for a blue badge is £10.00. This must either be paid by *credit/debit
card, cash or by cheque. We will only issue successful applicants with a blue
badge once payment of the required fee has been received.
*denotes a charge of 1.2% when payment is made with a credit card.
We are only able to issue a blue badge to people who either pay their council
tax to Dudley MBC or receive council tax benefit from Dudley MBC. Applicants
whose council tax is paid to a local authority other than Dudley MBC or who
receive council tax benefit from a local authority other than Dudley MBC will
need to contact the Blue Badge Team within their own council.
When your application has been approved we will need to see the appropriate
documents confirming your identity and address. Without these your badge
cannot be processed. Please see the final page of these guidance notes for a
list of acceptable proofs of identity and address.
All applicants should complete sections 1, 2, 3, 13 and 14. Applicants will also
need to complete:
 Section 4 if they are registered severely sight impaired (blind) or if they
wish to be registered blind and have a Certificate of Vision Impairment
(CVI) signed by a Consultant Opthalmologist which states that they are
severely sight impaired (blind)
 Section 4 if they are in receipt of one of the following awards or benefits
– Higher Rate of the Mobility Component of Disability Living Allowance, a
“Moving Around” descriptor for the Mobility Component of Personal
Independence Payment (PIP), War Pensioner’s Mobility Supplement, or
the Armed Forces and Reserve Forces (Compensation) Scheme within
tariff levels 1-8 (inclusive)
 Sections 5-9 inclusive if they have a permanent and substantial disability
which causes inability to walk or very considerable difficulty in walking
 Section 10 if they are a driver who has a severe disability in both arms
and is unable to operate, or has considerable difficulty operating, all or
some types of on-street parking equipment
 Section 11 if the applicant is a child under the age of 3 who must be
accompanied by bulky medical equipment or who needs to be kept near
a vehicle at all times, either for treatment or for transportation to a
location where treatment can be performed
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Section 1 - Information about the applicant
This section asks for personal details of the applicant including name, date of
birth, National Insurance/Child Registration number, address and telephone
number. All fields should be completed. Name at birth refers to people whose
name on their birth certificate has changed, eg the applicant has married and
their name has changed. If there has been no change in name then please
indicate “as above”.
If you are applying for a blue badge on behalf of someone under the age of 16,
then you will need to provide their Child Registration Number. This can be
found on Child Benefit documentation.
Section 2 – Ethnic origin
To help us monitor our equal opportunities policy you are requested to tick the
appropriate box in this section. Your answer will not affect your application.
Section 3 – Type of application
Please complete this section as appropriate. There are questions for those who
already have a blue badge which is due to expire shortly. The expiry date
should be in the relatively near future, and two badges will not be valid for one
applicant at the same time. The serial number can be found on the front of the
badge.
Questions for ‘without further assessment’ (automatically eligible)
applicants
Section 4 – Entitlements/registrations
You will be automatically eligible for a badge if you are more than three years
old, can satisfy residency and identity checks, and meet at least one of the
eligibility criteria in Section 4.
You will need to provide the appropriate documentation once your application
has been processed, to prove eligibility under one of the criteria. You do not
need to send in proof with your application, but if you are asked to come in to
the office you will need to bring the appropriate documents.
Section 4a: for those registered as severely sight impaired (blind) - you are
asked to state the name of the local authority or borough with which you are
registered. You should state the county, metropolitan district or London
borough council.
In many cases, you will be registered with the same authority to which the
application for a badge is being made. If this is not the case, local authorities
will check with the named authority that you are registered as severely sight
impaired (blind).
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The formal notification required to register as severely sight impaired (blind) is a
Certificate of Vision Impairment (CVI). This will be signed by a Consultant
Ophthalmologist and forwarded to our Visual Impairment Section. However,
registration is voluntary.
Section 4b: for those who receive the Higher Rate of the Mobility
Component of Disability Living Allowance (HRMCDLA) – if you are in
receipt of HRMCDLA you will have been sent an award notice letter from the
Department of Works and Pensions (DWP). You will also have been sent an
annual uprating letter every April, stating your annual increase and this letter
can be used as proof of receipt of HRMCDLA if the original award letter is more
than 12 months old. If you have lost your HRMCDLA award letter or your
annual increase letter, then please contact the PCDS to request a current
award letter by:
- Telephone: 08457 123 456
- Textphone: 08457 22 44 33
- Email: [email protected]
This helpline is open from 8.00am to 6.00pm Monday to Friday, and further
details can be found online at: https://www.gov.uk/dla-disability-livingallowance-benefit/what-youll-get
If you receive the HRMCDLA and drive a motability vehicle we will still need to
see your DLA award letter as above. If you can only produce your tax disc or
insurance documents we will only be able to issue your blue badge up to and
including the expiry date of the disc or insurance.
Please note that if you are only in receipt of the Care Component of
Disability Living Allowance, or if you are in receipt of Attendance
Allowance, this does not qualify you automatically for a Blue Badge
Section 4c: for those in receipt of a Personal Independence Payment (PIP)
whose decision letter states that you meet one of the applicable “Moving
Around” descriptors within the Mobility Component – if your decision letter
states that you meet one of the following “Moving Around” descriptors within the
Mobility Component:
 You can stand and then move unaided for more than 20 metres but no
more than 50 meters (8 points)
 You can stand and then move using an aid or appliance for more than 20
metres but no more than 50 metres (10 points)
 You can stand and then move for more than 1 metre but no more than 20
metres (12 points)
 You cannot stand or move for more than 1 metre (12 points)
Your decision letter can be used as proof of receipt of the relevant PIP award.
If you have lost your PIP decision letter then please contact DWP for a PIP
letter by:
- Telephone: 0845 850 3322
- Textphone: 0845 601 6677
This helpline is open from 8.00am to 6.00pm Monday to Friday and further
details can be found online at: https://www.gov.uk/pip
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Section 4d: for those who receive a War Pensioner’s Mobility Supplement
(WPMS) – an applicant receiving WPMS will have been sent an official letter by
the Service Personnel and Veterans’ Agency demonstrating receipt of the grant.
If you have lost this letter, then the agency can be contacted via the freephone
enquiry number: 0800 169 22 77.
Section 4e: for those who receive a lump sum benefit under the Armed
Forces and Reserve Forces (Compensation) Scheme within tariff levels 18 (inclusive) and who have been assessed and certified by the Service
Personnel and Veterans’ Agency as having a permanent and substantial
disability which causes inability to walk or very considerable difficulty in
walking – you will have been issued with a letter from the Service Personnel
and Veterans’ Agency confirming the level of your award and also confirming
that you have been assessed as having a permanent and substantial disability
which causes inability to walk or very considerable difficulty in walking. You
must bring in the original copy of this letter as proof of entitlement once your
application has been processed. If you have lost this letter, then the agency
can be contacted via the freephone enquiry number: 0800 169 22 77.
Questions for ‘subject to further assessment’ applicants with walking
difficulties
Section 5 – Medical conditions/disabilities
Section 5 is to be completed if questions in Section 4 do not apply to you and if
you have a permanent and substantial disability which means you cannot walk
or which means that you have very considerable difficulty walking. A
permanent disability is one that is likely to last for the duration of your life.
Medical conditions such as asthma, autism, psychological/ behavioural
problems, Crohn’s disease/incontinent conditions and Myalgic
Encephalomyelitis (M.E.) are not in themselves a qualification for a badge.
People with these conditions may be eligible under this criterion, but only if they
are unable to walk or have very considerable difficulty in walking, in addition to
their condition. Applicants are asked to describe the nature of their disability.
Please provide evidence (in the form of letters from your GP or consultant)
where possible as this will help us to make a quick decision as to your eligibility.
Section 6 – Medication
Please provide accurate information regarding your current medication. You
may be required to bring with you proof in the form of prescriptions or medical
letters.
Section 7 – Mobility
You should read through section 7 then tick the box next to the statement or
statements which best describe your walking ability. Please use the boxes
below the statements to provide additional information which could help us to
make a decision regarding your application.
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Section 8 – Distance
In section 8 you should provide an estimate of the maximum distance you can
walk without assistance or severe discomfort.
It can be difficult to accurately work out the distance you can walk. The
following local examples of 80 metre distances may assist:
From
To
McArdle’s Pharmacy, High Street
Barclay’s Bank, High Street
Brierley Hill Library, High Street
Dog & Partridge Pub, High
Street
Coseley (Roseville)
Post Office, High Street
Wilf Gilbert betting shop
Dudley
Fountain, Town Centre (opposite
HSBC Bank)
Public toilets (end of market)
Halesowen
Wilkinson, High Street
Somers Square
Cornbow Centre (Hagley Street
entrance)
Superdrug, Cornbow Centre
Kingswinford
Kingswinford Cross
Kings’ Fish Bar, Market Street
Merry Hill
Disabled parking bays (ground
floor multi-storey)
Clas Ohlson (opposite
McDonald’s)
Argos main entrance
F Hind Jewellery store
Sedgley
Post Office, High Street
Gregg’s The Bakers, High
Street
Stourbridge
Ryemarket entrance (by
Waitrose)
Costa Coffee
Wilkinson, High Street
Halifax Building Society, High
Street
Brierley Hill
If you still find it difficult to work out the distance you can walk in metres, please
tell us:

The number of steps you can take, and how long, in minutes, it
would take you to walk this distance

About your walking speed
Section 9 – Treatment/surgery
Please use this section to tell us of any surgery or treatment which you have
undergone or are likely to undergo in relation to your condition/disability.
If you are having an operation within the next 12 weeks please let us know on
the application form. This will assist us identify the most appropriate time to
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assess you. Sometimes we may need to delay your assessment. We usually
assess 8 weeks after surgery once you have had a review with your consultant.
NB: Blue Badges are not issued for short periods of time when mobility is
affected temporarily after surgery.
Please include details of any health care professionals who have been treating
you, including doctors, consultants, distinct nurses, physiotherapists,
occupational therapists and social workers.
Section 10 – Questions for ‘subject to further assessment’ applicants with
disabilities in both arms
Section 10 is for applicants over the age of three who have a severe disability in
both arms. You will need to show that you drive a vehicle regularly, that you
have a severe disability in both arms and that you are unable to operate, or
have considerable difficulty operating, all or some types of on-street parking
equipment. You will need to satisfy all three conditions above in order to obtain
a badge.
Section 11 – Questions for ‘subject to further assessment’ applicants
under the age of three
Section 11 covers:
 children under three years of age who have a medical condition
which means that they must always be accompanied by bulky
medical equipment which cannot be carried around with the child
without great difficulty; or
 children under three years of age who have a medical condition
which means that they need to be kept near a vehicle at all times,
either for treatment, or for transportation to a location where
treatment can be performed.
A parent or guardian must apply on behalf of a child under the age of three.
The list of bulky medical equipment referred to above may include:
 ventilators;
 suction machines;
 feed pumps;
 parenteral equipment;
 syringe drivers;
 oxygen administration equipment;
 continuous oxygen saturation monitoring equipment; and
 casts and associated medical equipment for the correction of hip
dysplasia.
A local authority may issue a badge if the equipment is always needed and
cannot be carried without great difficulty.
Examples of highly unstable medical conditions that mean children who have
them may need quick access to transport to hospital or home are:
 tracheostomies;
 severe epilepsy/fitting;
 highly unstable diabetes; and
Page 15 of 17
 terminal illnesses that prevent children from spending any more than
brief moments outside and who need a quick route home.
Please note that the above lists are not exhaustive, to allow for new advances
in technology and treatment equipment.
A letter will be required from a healthcare professional who has been involved in
your child’s treatment (for example, GP or paediatric consultant) giving details
of the child’s medical condition and the impact that this has upon mobility, and
the type of medical equipment they need.
Section 12 – Further information
Completion of this section is optional. Please use if there is any other
information you wish to provide us with regarding your application which has not
been included elsewhere in the form.
Section 13 – Declarations and signatures
Section 13a: Mandatory declarations must be completed by all applicants, since
they underpin the terms of applying for a Blue Badge. Please take the time to
read and understand these declarations, since not ticking them may result in
Dudley MBC being unable to accept your Blue Badge application.
Section 13b: You may wish to tick the optional declarations in order to speed up
your application and improve the service you receive from Dudley MBC. In
doing so, you will be providing specific consent to allow us to share information
about you with relevant departments and service providers within the authority.
Section 13c: All applicants must sign and date the form prior to submitting it.
A local authority may refuse to issue a badge if they have reason to
believe that the applicant is not who they claim to be or that the badge
would be used by someone other than the person to whom it has been
issued.
Once completed, please return this form to:
Blue Badge Team
Brierley Hill Health and Social Care Centre
Venture Way
Brierley Hill
DY5 1RU
Alternatively you can scan and email it to: [email protected]
If your badge application is successful, the leaflet “The Blue Badge scheme –
rights and responsibilities in England” will be sent to you with the badge. This
leaflet explains the rules of the scheme and how to use the badge properly.
The leaflet can be viewed at: https://www.gov.uk/government/publications/theblue-badge-scheme-rights-and-responsibilities-in-england
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Checklist of documents you will need to produce
A local authority may refuse to issue a badge if they have reason to believe that the applicant is
not who they claim to be or that the badge would be used by someone other than the person to
whom it has been issued.
Please ensure that when you attend the issuing office you bring all of the relevant documents
for the sections of the application form that you have completed because they are relevant to
you. We have provided a checklist to help remind you what you need to bring: Please do not
send in any of these documents with your application form.
Proof of your address, dated within the last 3
months – preferably a council tax bill, although
other acceptable forms of proof are: award letter
from SPVA; benefit award letter from DWP;
confirmation letter from social service/other local
authority department that you are resident in that
area; confirmation letter from school that child
Section 1 – Information about
attends that school; housing benefit award letter;
you
pension service letter; driving licence
Original proof of your identity (photographic proof if
possible) – this can be: a birth certificate;
certificate of British nationality; civil partnership/
dissolution certificate; HM Forces ID card; ID card
for foreign nationals; marriage/ divorce certificate;
passport; adoption certificate; driving licence
Section 4a – People who are
severely sight impaired
A copy of your ophthalmologists report/ CVI/BD8
form (if you have not given us consent to check the
blind register)
Section 4b – People who
receive the Higher Rate
Mobility Component of
Disability Living Allowance
An original letter of entitlement for the HRMCDLA
from the DWP issued within the last 12 months, or
an original copy of your annual uprating letter. NB
please note that we may also check that you are in
receipt of this award with the Department for Work
and Pensions
Section 4c: People in receipt of
a Personal Independence
Payment (PIP) whose decision
letter states that they meet one
of the applicable “Moving
Around” descriptors within the
Mobility Component
An original decision letter can be used as proof of
receipt of the relevant PIP award
Section 4d – People who
receive the War Pensioner’s
Mobility Supplement
An original letter of entitlement for the War
Pensioner’s Mobility Supplement
Section 4e – People who
receive an award under the
Armed Forces and Reserve
Forces (Compensation)
Scheme
Section 11 – Children under
three years old
An original award letter confirming receipt of tariffs
1-8 under the Armed Forces and Reserve Forces
(Compensation) Scheme, which also certifies that
you have a permanent and substantial disability
which causes inability to walk or very considerable
difficulty walking
A letter explaining how your child’s condition
impacts upon their mobility will be required from a
healthcare professional who has been involved in
your child’s treatment
Please note that you will not be required to provide a photograph to accompany
your application. However, should your application be successful, you will be
required to attend the office so that a digital photograph can be taken; this will be
printed onto your badge.
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