Residents Parking Permit Application Form
Version 6 - Feb 16
Please fill in the boxes where applicable
1.
YOUR DETAILS
Title:
Forename:
Date of birth:
Address:
Surname:
Email address:
House no:
House name / flat number:
Street name:
Telephone:
Post code:
Daytime:
Evening:
Name of business (if applicable):
If you are a new resident at this address please tell us the date you moved in:
You will need the following documents (please refer to guidance):
2.
PERMITS
Please tick:
1st Permit

Proof of residence

Proof of eligibility to drive each vehicle
If it is a replacement permit please
select from the following:
Renewal
Registration:
Vehicle colour:
Make:
Model:
Change of
vehicle
Lost, stolen or
damaged
IMPORTANT: IF ANOTHER 1ST PERMIT ALREADY EXISTS AT THIS ADDRESS IT WILL AUTOMATICALLY BE
MADE VOID ON COMPLETION OF THIS APPLICATION
Please tick:
2nd Permit
If it is a replacement permit please
select from the following:
Renewal
Registration:
Vehicle colour:
Make:
Model:
Change of
vehicle
Lost, stolen or
damaged
IMPORTANT: IF ANOTHER 2ND PERMIT ALREADY EXISTS AT THIS ADDRESS IT WILL AUTOMATICALLY BE
MADE VOID ON COMPLETION OF THIS APPLICATION
You will need the following document (please refer to guidance):
3.
VISITOR VOUCHERS
 Proof of residence
You can request a maximum of two booklets per
household at a cost of £7.50 each
4.
SPECIAL PERMITS
Please enter number of booklets
required:
You will need the following documents (please refer to guidance):
 Proof of residence

Please tick:
Care provided by:
Special permit
BMBC Social Services
Letter from care organisation if not BMBC
If other, please specify:
If your care is provided by a family member or friend, please complete the Special Permit Application for
Voluntary Care
5.
COSTS
Resident Permits (Please tick)
Business Permits (Please tick)
1st Permit
£20
£30
2nd Permit
£40
£60
Replacement Permit (change of vehicle or lost)
£5
£10
Replacement Permit (Faded)
Free of charge
Free of charge
Special Permit
Free of charge
Visitor Voucher Books
£7.50 per book
6.
7.
TOTAL COST
METHOD OF PAYMENT
Please tick if you've paid with your
debit or credit card
n/a
£7.50 per book
£
Enter your receipt
number here:





Credit card payments are subject to a 2.2% charge
You must now return your completed application form with supporting documents
If you have difficulty paying in this way, please telephone 01226 772649 and speak to a member of staff
Please note that cash, cheques and postal orders are no longer accepted as payment for permits/vouchers
Failure to make the correct payment before submitting your application will delay the issue of your
permit(s)/vouchers
 Parking Permits are not subject to VAT
8.
DECLARATION AGREEMENT
 I hereby declare that my normal place of abode / business premise is at the address shown on this form.
 I wish to apply for Resident’s/Business Permit(s) in respect of the vehicle(s) shown on this form and/or I wish to apply for a
book(s) of Visitor Vouchers.
 I certify that I will only issue my Visitor Vouchers to drivers who are visiting me at the address shown on this form or
where special circumstances have been authorised by the Council.
 I understand that any permit(s) issued to me by the Council is(are) for the vehicle(s) and address shown on this form and
that such issue and any subsequent issue of a permit is conditional on my surrendering to the Council said permit in the
event of any of the following;

My ceasing to be a resident / business owner of the address shown on this form.

My ceasing to be eligible to drive the vehicle(s) shown on this form.

Upon the issue to me of a duplicate/replacement permit.
 I understand that any suspected abuse of permits and/or Visitor Vouchers issued to myself will be investigated and may
result in my permit and/or Visitor Voucher entitlement being withdrawn and/or the issue of a Penalty Charge Notice/fine.
 Any person knowingly making a false statement for the purpose of obtaining a parking permit commits an offence under
Section 115(2) of the Road Traffic Regulation Act, 1984 and will be liable to a substantial fine.
The personal information you provide on this form will be used by the Council for parking permit purposes. By signing this
form you are consenting to our processing this data for the purpose of issuing residents, business and visitors parking
permits. Your information will be processed in accordance with the principles of the Data Protection Act 1998.
We are required under the Audit Commission Act 1998 to take part in the National Fraud Initiative (NFI) data matching
exercise. In order to protect public funds we advise that the information you have given on this form may be used for the
prevention and detection of fraud. You can find more details about this on our website at http://www.barnsley.gov.uk by
searching for ‘data matching’ or by following this link https://www.barnsley.gov.uk/services/information-andprivacy/data-matching/.
I confirm that I have read the Parking Permit Information Sheet and declare that to the best of my knowledge all the
details included on this form are correct.
Your signature:
Submitting your application electronically will act as your signature
What happens now?



Submit your completed application form along with your
supporting documents by email to our
[email protected] mailbox
If we have any questions about your application after we’ve
checked it, we’ll contact you, preferably by email or telephone
Once your application is approved, your permit(s) and/or
vouchers will be sent to you as soon as possible
Date:
FOR OFFICE USE ONLY
______________________
permit issued
______________________
Special permit issued ______________________
Visitor vouchers issued ______________________
Date processed
______________________
Initials
______________________
1st permit issued
2nd