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European Blue Parking Badge for Disabled People

1. Applicant's Details

This application should be completed with the details of the disabled person. Please complete all sections that apply.

Title ^*

First Names ^*

Last Name ^*

Also Known As

Address line 1 ^*
Address line 2
Address line 3
Postcode ^*

Telephone Number

Date of Birth

National Insurance Number ^*

Email Address

Are you a Blue Badge holder?

YesNo

If yes, please provide expiry date

Where was the badge issued?

Please state whether your badge was issued by North East Lincolnshire Council or another authority

DATA PROTECTION NOTICE
North East Lincolnshire Council is a Data Controller for the purposes of the Data Protection Act 1998. Any personal information supplied on this form will be processed in accordance with the principles of the Act. If you want to find out more about your rights under the Act, you can contact the Office of the Information Commissioner (tel: 01625 545 700 / http://www.dataprotection.gov.uk) or the Director of Law and Democratic Services on 01472 313131.

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Created by	:	Community Care
Last Updated	:	13 February 2007



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