The Blue Badge Scheme
Application for an Organisational Badge
Official Use Only:
Serial Number ___________________
Date Received _____/_____/_________
This form should only be completed if you are representing an organisation
and are applying for an organisational badge.
An organisational badge will only be issued to organisations who can
demonstrate that their responsibility includes the care and transportation of
disabled people who would meet the eligibility criterion for a badge should
they apply individually.
In all circumstances, badges will be supplied to organisations rather than to
individual staff members.
Data Protection Act 1998
The personal information on this form is to be kept safe, and is protected by Law.
This means that:
 We only use it for the purpose given on the form
 We only share it with people who need to know it
 We only keep it for as long as we have to
 You have the right to see the information we hold about you
Section A
New application:
Renewal:
Organisation name: _____________________________________________________________
Address Line1:_________________________________________________________________
Address Line2:_________________________________________________________________
Address Line 3:_________________________________________________________________
Town: _____________________________
Postcode: ____________________________
Email: (if applicable) _____________________________________________________________
Telephone no: __________________________________________________________________
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Section B
If you are applying to renew any Blue Badges then please complete B1. If not please go
straight to section B2.
Section B1
Serial Number
Expiry Date
Description of
vehicle used e.g. Minibus,
ambulance
Vehicle
registration
number
Section B2
Does your organisation care for disabled people?
Yes
No
If yes, please provide details below:
As part of that care, does your organisation provide them with transportation?
Yes
No
If yes, give details of the type of vehicles used to transport disabled people.
Are any of your vehicles licensed under the Disabled Passenger Vehicle (DVP) taxation
class?
Yes
No
If yes, please attach a photocopy of the tax disc(s) to this application.
Please note that organisations that do not have vehicles licensed under the DVP
taxation class will also be considered.
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Please specify the number of drivers who will be transporting
your clients
Please specify the number of disabled people who
meet any the following eligibility criteria

Are registered blind (partially sighted does not qualify)

Receive the higher rate of the mobility component of the Disability Living
Allowance (Attendance Allowance does not qualify)

Receive a War Pensioners Mobility Supplement or a benefit under the Armed
Forces and Reserve Forces (compensation) scheme

Regularly drives an adapted or non-adapted vehicle and has a severe
disability in both arms and is unable to operate, or has considerable difficulty
operating, all or some types of parking meter

Have a permanent and substantial disability which causes inability to walk or
very considerable difficulty walking. The scheme is only intended for VERY
DISABLED PEOPLE.
Please describe why you are applying for an organisational badge (including how often it
will be used and for what purpose?)
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Declaration
1. I declare that, to the best of my knowledge, all of the information I have provided is correct
2. I understand that I must let Derbyshire County Council know of any changes that could affect
the applicants entitlement to a Blue Badge as soon as possible
3. I on behalf of my organisation agree to Derbyshire County Council sharing information on this
form with other local authorities responsible for Blue Badge schemes and with parking
enforcement agencies for the purpose of preventing and detecting crime.
4. I on behalf of my organisation agree to pay a fee of £10.00 per badge should this application
be successful. Details of how to pay this charge are provided in a letter which is sent to
successful applicants.
Name: __________________________________
Date: ____/____/_________
Checklist
I have enclosed: A copy of the organisations logo or headed paper
Applications WILL NOT be dealt with in person
Please return this form to:
BlueBadges@derbyshire.gov.uk
or by post to: Blue Badge Section
Derbyshire Business Centre
County Hall
Matlock
DE4 3AG
Please remember to attach a
copy of your organisations logo
or headed paper
Data Protection Law
Data Protection Law requires us to tell you how we will use the information you have
provided as part of this application. The information we ask for helps us decide whether
you are entitled to a disabled person’s car badge, unless otherwise stated. Derbyshire
County Council will hold the information you have given.
The Chronically Sick and Disabled Persons Act 1970 forms the basis of identifying what
information we collect to enable a decision to be made. This process is covered by
section 21 of the Act and regulations made under it.
Derbyshire County Council is under a duty to protect the public funds we administer,
and to this end may use the information you have provided for the prevention and
detection of fraud. We may also share this information with other bodies responsible for
auditing or administering public funds for these purposes.
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