Resident�s Parking Permit Application Form

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					Resident’s Parking Permit Application Form 2012-2013
(Portesbery Road Car Park)


1. Please complete all sections of the application form and sign it. If you don’t, then your application may be

2. When you have completed your application form, please either post it or take it in person to: Surrey Heath
        Borough Council, Knoll Road, Camberley Surrey GU15 3HD. Opening hours are Monday to Thursday 8.30am
        to 5.30pm and Friday 8.30am to 5.00pm (excluding bank holidays).

3. Make sure you include all necessary supporting documents and the full amount payable (or card details).
        Please allow 14 days for the delivery of your permit. If you take your application to Surrey Heath House, Knoll
        Road, Camberley, you will have the option of paying by card or cash at our payment machine in the Reception
        area. If you have any problems or queries making your application, please contact Parking Services at Surrey
        Heath Borough Council on 01276 707477 for assistance.

4. In accordance with the off-street parking places order, the Council may take account of your own off-street
        parking in assessing your application. Permits will be valid in Portesbery Road car park only.

5. A vehicle may not park in a permit parking place until all necessary paperwork has been processed, you have
        received your permit and it is displayed in the vehicle.

Personal details…Please write clearly in BLOCK CAPITALS
Title                                          Forename

Surname                                                                                       Guidance Notes

Full address                                                                                  This must be your
                                                                                              usual residence, where
                                                                                              you normally sleep at
                                                                                              least 4 nights a week


Email address

Evidence that you qualify to apply for for a permit

                         Current council tax bill                                              All proofs must show the
                                                                                               address and be dated
                         Driving licence
                                                                                               within 3 months other
Please enclose 2         Utility bill                                                          than the council tax bill,
proofs of                                                                                      driving licence or
                         Credit/store card/mail order statement
addresss and tick                                                                              tenancy agreement
the                      Benefit agency/pension statement                                      (which must be current)
corresponding            Bank/Building society statement
boxes                                                                                          Personal documents
                         Legal letter of completion
                                                                                               may have financial
                         (valid 3 months from move in date)                                    details omitted.
Your own parking                                                                  Yes    No
                                                                                               Priority is given to
                         Does your household have exclusive use of any off-                    applicants with no off-
                         street parking place where your vehicle could be                      street parking

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Vehicle details... Please write clearly in BLOCK CAPITALS
Registration                                                                                           Your vehicle must be one
Number                                                                                                 of
Make                                                                                                   the following:
                                                                                                       1. Up to 8 people including
                                                                                                       the driver
Model                                                                                                  2. A goods vehicle up to
                                                                                                       1.5t unladen weight and
Colour                                                                                                 up to 2.1m height
                                                                                                       3. A motorcycle
                                                                                                       4. An invalid carriage
Proof of Vehicle                                                                                       This must demonstrate
ownership                                                                                              that you own or have
                         Vehicle registration document-V5C
(please tick one                                                                                       authority to keep the
and enclose a                                                                                          vehicle. If your name is
                                                                                                       not on the vehicle
copy)                                                                                                  registration document
                         Company car letter
                                                                                                       (V5C) then you must
                                                                                                       provide evidence that you
                                                                                                       are entitled to have the
                                                                                                       vehicle e.g. Company car
                         Current motor insurance certificate
                                                                                                       letter or current insurance
I declare that:
              I am resident (at least four nights a week) at the address given and that the vehicle identified above is
               owned/primarily used by me.
              the vehicle is applied is a passenger vehicle for up to 8 people (inc. the driver), a goods vehicle up to 1.5t unladen
               weight and up to 2.1m height.
              I have read the conditions of eligibility regarding the issue of the Residents Parking Permit and I believe I am
               entitled to apply for a permit. I will use it in accordance with the conditions of issue.

I undertake to return the permit to Surrey Heath Borough Council if:
             I cease to be a resident as defined in the appropriate order, or
             I cease to be the user of the vehicle detailed, or
             the vehicle specified overleaf is adapted or used in such a manner that it ceases to be one of the types specified
              above, or vehicle or a goods carrying vehicle or a goods carrying vehicle
             I am issued a replacement permit, or

I accept that:
              A replacement permit for one that has been lost, stolen or damaged and a permit reissued for a change of
               registration, are subject to a £15 fee.
              Refunds will be given for unused complete months on return of the permit to the Council.

I understand:
             that you will use the personal information I have given in line with the Data Protection Act 1998. You will use the
              information I have given to issue resident parking permits. I accept that you will pass this information to other
              council departments and the DVLA, for this and related purposes.
          that you have to protect the public funds you handle, so you may use the information I have provided on this form
              to prevent and detect fraud. You may share this information with other bodies who handle public funds for these
              purposes only.
             For further information, see
The Council may initiate legal proceedings against anyone dishonestly obtaining or attempting to obtain a parking
Signature (must be completed by all applicants)
Signature                                                                  Date                        Unsigned applications
                                                                                                       will not be processed
SHBC Office use only
Fund 21: 14-141-810-14001-S
Fund XC: 20-200-820-20005-S (credit card fee only)                  Permit No:

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Payment for residents parking permit(s) – Portesbery Road 2012/2013
Name on application/company name

                                                                                      Permits to be issued during the year are charged
Amount payable                                     £                                  pro rata by calendar month, or part thereof, to the
£100 per year or pro rata                                                             end of March.

Cheque payments
Cheque enclosed (please tick)                                    Please make cheque payable to: Surrey Heath Borough Council

Card payments

     The Council accepts the following debit and credit cards:

     Visa Credit Card
     Visa Debit Card
     MasterCard Credit Card
     Electron Card
     SOLO card
     Maestro Domestic UK
     MasterCard Debit

     To protect against card misuse we do not process card details by post. If you want to pay using one of these methods, please provide
     up to two telephone numbers on which you can be contacted during office hours. Once your application has been processed, a
     member of staff will call you to carry out the transaction. Please note that payments by credit card are subject to a 1.5%

Name of Cardholder

Address of Cardholder

Contact telephone number/s                          1


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