Form BB4.1
These questions are intended for organisations involved in the care of disabled people who are seeking a Blue Badge for a vehicle/vehicles (e.g. minibus, or specially adapted commercial vehicle) which is/are to be used to carry disabled people who would themselves qualify for an individual Blue Badge in the regulations that govern the scheme.
Applications can take up to 4 weeks to be considered. You will be notified of the outcome of your application in writing.
Section 1 - Details of the Organisation
Name of Organisation:
Contact Name:
Address of
Organisation:
Telephone:
Email:
Is your Organisation currently in receipt of a Blue Badge?
Date
Yes No Unknown
Is this a new or a renewal application?
New Renewal
Initial
Scan
Library
Office Use Only
No. Pages
No. Badges
Badge Exp
DS SS blue.badges@westsussex.gov.uk Page 1 of 4 Blue Badge Helpline: 01243 777653

Form BB4.1
Please list the badge serial numbers you wish to renew:
(if applicable)
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Section 2 – Eligibility of the Organisation
In order to be eligible for a Blue Badge an organisation must be one that both cares for and transports disabled people who would themselves qualify for an individual Blue
Badge. Organisational badges will therefore only be issued to an organisation which:
 Cares for and transports disabled people who would meet one or more of the eligibility criteria for an individual badge; and
 Due to the number and frequency of disabled people it is transporting, has a clear need for an organisational badge rather than using the individual badges of people it is transporting
Individual badges may be issued to people who fall within one or more of the following descriptions:
 Has a permanent and substantial disability that causes inability to walk or very considerable difficulty in walking
 Is registered blind
 Receives the Higher Rate of the Mobility Component of the Disability Living Allowance or 8 points or more under the “moving around” activity of the mobility component of the Personal Independence Payment (PIP)
 Receives a War Pensioner’s Mobility Supplement or has been awarded a lump sum benefit at tariffs 1-8 of the Armed Forces Compensation Scheme and certified as having a permanent and substantial disability that causes inability to walk or very considerable difficulty in walking
Does your organisation care for disabled people who would themselves qualify for an individual Blue Badge?
Yes No If Yes; approximately how many disabled people are in your care? blue.badges@westsussex.gov.uk Page 2 of 4 Blue Badge Helpline: 01243 777653

Form BB4.1
Please outline the needs of your customers and the care you provide:
Does your Organisation provide disabled people with transport as part of this care?
Yes No
If yes; please give details of the vehicle(s) in which a badge would be used:
Vehicle
Registration
Vehicle Make
(e.g. Ford, Mercedes,
Peugeot)
Vehicle Type (e.g. minibus, MPV, car)
Is this vehicle wheelchair
Accessible?
How often does your Organisation transport disabled people?
Every day Most days Weekly Other
(Please state)
What type of journey does your Organisation make with disabled people?
(e.g. hospital appointments, excursions etc)
How many badges are you applying for?
(Please note the £10 fee is payable for each badge) blue.badges@westsussex.gov.uk Page 3 of 4 Blue Badge Helpline: 01243 777653

Form BB4.1
Declarations: Please read the following declarations thoroughly and tick all relevant boxes. Not ticking one of these declarations may mean we are unable to issue your organisation with a Blue Badge.
I confirm that, as far as I know, the details I have provided are complete and accurate. I realise that
you may take action against me if I have provided false information in this application form.
I understand that I must promptly inform West Sussex County Council of any changes that may
affect my organisation’s eligibility for a badge.
I confirm that I am authorised to represent the organisation.
I confirm the badge will only be used when transporting disabled people and that the badge will only
be used in accordance with the rules of the scheme.
Your signature against the above declarations:
Print Name:
Date of Application:
Data Protection Notice
All documents relating to this application will be dealt with in line with the Data Protection Act 1998 and may be shared within West Sussex County Council, with other local authorities, the Police and Civil Parking Enforcement
Officers to detect and prevent fraud. Any medical information that you have supplied to support this application is deemed under the Act to be ‘sensitive personal data’ and will only be disclosed to third parties as necessary for the operation and administration of the Blue Badge Scheme, and to other Government Departments or agencies to validate proof of entitlement or as otherwise required by law.
Payment for badge and badge collection:
Please do not send any payment with your application. You will be notified of the outcome of your application in writing. Successful applicants collect and pay the £10.00 fee for their badge in person at a library.
Please indicate the library you will collect your badge from should your application be successful (from the following list of West Sussex libraries):
Angmering
Burgess Hill
Ferring
Horsham
Pulborough
Southwater
Arundel
Chichester
Findon Valley
Billingshurst
Hurstpierpoint Lancing
Rose Green
Southwick
Rustington
Steyning
Bognor Regis
Crawley Durrington
Goring by Sea Hassocks
Littlehampton
Selsey
Storrington
Broadfield Broadwater
East Grinstead East Preston
Haywards Heath Henfield
Midhurst
Shoreham
Witterings
Petworth
Southbourne
Worthing
Please send your completed application form together with a copy of your
Organisation’s logo (this will appear on the badge) to:
By Post: Blue Badge, PO Box 859, Bognor Regis, PO21 9HT
By Email: blue.badges@westsussex.gov.uk blue.badges@westsussex.gov.uk Page 4 of 4 Blue Badge Helpline: 01243 777653