REN/CH
PARKING PERMIT – RENEWAL / CHANGE
APPLICATION FORM
Please read the accompanying letter carefully before completing this form.
All sections must be completed (please use CAPITAL LETTERS).
TITLE (eg Mr/Mrs/Miss/Ms)
SURNAME
FIRST NAME
ADDRESS
TELEPHONE NO(s)
Home
Work
BLUE BADGE HOLDERS If issued by LB Merton please supply serial number
All other Badge holders please supply a photocopy of both sides
SERVICE REQUIRED, tick appropriate box
Change of Address
Renewal – state 6 or 12 months
Change of Vehicle
EXISTING PERMIT NUMBER AND EXPIRY DATE
NEW ADDRESS
YOU ARE REQUIRED TO PROVIDE PROOF OF RESIDENCE IF THIS APPLICATION IS CONNECTED
WITH A CHANGE OF ADDRESS AND/OR RENEWAL OF PERMIT AND YOU ARE NOT ON THE
ELECTORAL ROLL
EXISTING VEHICLE REGISTRATION No.
NEW VEHICLE
(if applicable)
MAKE
NEW VEHICLE REGISTRATION No.
MODEL
COLOUR
IF YOU HAVE CHANGED YOUR VEHICLE, PROOF OF VEHICLE OWNERSHIP IS REQUIRED
.
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FOR OFFICE USE ONLY
Documents
ZONE/SUB ZONE
Driving Licence
Electoral Roll
PERMIT NUMBER
VRD
Referee
EXPIRY DATE
HELPLINE 020 8545 4661
Checked By
Date
DECLARATION
Please sign and date the declaration. Note that a false statement could lead to prosecution by the Council on
fraud charges.
I declare:
i) I have read the Residents Parking Permit leaflet and Understand the terms and conditions of the permit issue
and that I reside principally at the address shown in this application (ie for at least four days and nights per week)
and the motor vehicle described is kept and used by me .
ii) that all the information given in this application is correct. I further declare that I have read the Residents
Parking Permit leaflet and understand that making a false statement to procure a permit is a serious criminal
offence. I understand that if, during the currency of any permit, I cease to reside at the address declared as my
principal place of abode and/or I cease to be the keeper and user of the vehicle specified in this application that I
am required by law to destroy the Permit or return it to the Parking Services Section of the London Borough of
Merton and that it will be an offence for me to continue to use the permit.
In making this application I understand that authorised officers of the London Borough of Merton may check
statements made in this application against the Electoral role.
Signature
Full Name (In Block Capitals)
Return completed form to: Parking Services
Merton Civic Centre,
London Road ,
Morden,
Surrey. SM4 5DX
Date
PAYMENT
I enclose a cheque/postal order for the sum of £_________ made payable to the London Borough of Merton.
Please write the applicant’s name and address on the reverse of the cheque.
CREDIT CARD PAYMENT - ACCESS, VISA, MASTERCARD, SWITCH, DELTA ONLY.
To the London Borough of Merton:
Please debit my credit card with the amount of £
CARD NO
Name
On Card
Start Date
Expiry Date
Signature
& Date
Switch Card Issue No