Application form
Parking permits for people with disabilities
Completing this form
1.
2.
3.
4.
Read the ‘Conditions of issue and use’ section before completing this form.
Complete all fields in BLOCK LETTERS.
Refer to the ‘How to apply’ section for more information.
Submit the completed form by mail, email or in person.
Note: The application will not be processed unless all details are completed.
Cardinia Shire Council aims to process all applications within 10 working days. If your application is
unsuccessful, Council will give reasons for its decision in writing. This form is for Cardinia Shire
residents only.
Section 1: Applicant details*
*This section must be completed by the applicant/agent. The applicant is the person with the disability.
Title: ……………………………………………………………
Phone no: …………………………………………….…….
First name/s: ………………………………...................
Mobile: ……………………………………….………………
Family name: ……………………………………………….
Date of birth ………………………………………………..
Residential address
Address: ………………………………………………………………………………………………………………………………………..
………………………………………………………………………………………………………………………………………………………
Postal address (if different from residential address)
………………………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………………………
Is the permit for:
☐Temporary
☐Passenger only
☐Driver/passenger
Drivers licence number: ……………….………………
Expiry date: …………………………………………………
Section 2: Statement of acceptance
This section must be completed by the applicant/agent.
I declare that the information I have provided is true and correct. I agree that I have read and
understood the permit ‘Conditions of issue and use’ and wish to apply for the selected permit to use in
accordance with these terms. I will ensure that the permit is not altered, sold transferred or assigned to
another party and will be solely used for the purposes as stated. I agree to return the permit if my
eligibility changes. I acknowledge information found to be false in support of this application will result
in my permit being cancelled.
The applicant’s agent may sign and take full responsibility on the applicant’s behalf.
Applicant name: ……………………………………………………………………………………………………………………………
Signature: ……………………………………………………
Date: ………………………………………………………….
Agents name: ……………………………………………………………………………………………………………………………….
Signature: ……………………………………………………
Date: ………………………………………………………….
Relationship: …………………………………………………………………………………………………………………………………
Cardinia Shire Council is committed to protecting your privacy. The personal information you provide on
this form, and in support of your application, is being collected by the Cardinia Shire Council for the
primary purpose of assessing your eligibility for the relevant parking permit. We may also need to
contact you from time to time for directly related purposes. Your personal information will not be
disclosed to any external party without your consent, unless required or authorized by law. We may
share your information with other councils in instances where permit misuse is suspected. Failure to
provide the information requested, means your permit application cannot be processed. If you wish to
gain access to, or later any personal information you have supplied to Cardinia Shire Council whilst
completing this application, please contact us on 1300 787 624. Access to our privacy statement is
available at www.cardinia.vic.gov.au
Section 3: Medical check
This section must be completed by a Medical Practitioner/Specialist Medical
Practitioner/Clinical Psychologist.
Patient’s name: …………………………………………………………………………………………………………………………….
What is your patient’s disability? ……………………………………………………………………………………………………
Yes or No
(please circle)
Does the disability affect their capacity to walk to such an extent that it may become severely
injurious to their health OR result in extreme danger to themselves or others in public place
without the continuous attendance of a carer?
Does the patient require the continual use of a complex aid for support or mobility? (wheelchair,
scooter, walking frame, full calliper, crutches, artificial limb, walking stick/s, etc.)
What mobility aid does your patient use?
Does the patient require additional space to access their vehicle due to the use
of complex mobility aid?
Does your patient require additional space to access his/her vehicle due to the disability?
Is the significant disability permanent?
If NO, a temporary permit of no less than 6 months will be issued.
Does the applicant require additional time? (rest breaks)
Additional supporting information known to you?
Yes
No
Section 4: Medical authority
This section must be completed by a medical practitioner/clinical psychologist.
I make this declaration in the firm belief that all information on this form for the applicant:
………………………………………………………………………………………………………………………………………………………
is, to the best of my knowledge, true and correct. I am aware that a false declaration is punishable
by law.
Name: ………………………………………………………………………………………………………………………………………….
Signature: ……………………………………………………… Date: …………………………………………………………………..
Please use stamp to verify
Note: Any charges associated with the medical check are to be met by the applicant.
How to apply
Return the completed form via one of the methods below. Keep the ‘conditions of issue and use’ page
for your reference.
Mail
Disabled parking permits
Cardinia Shire Council
PO Box 7
Pakenham VIC 3810
Email
mail@cardinia.vic.gov.au
In person
Cardinia Shire Council Civic Centre, 20 Siding Avenue, Officer
8.30am to 5pm, Monday to Friday (closed public holidays)
More information
Phone: 1300 787 624
Condition of issue and use
Applicant to retain.
Application form
1.
Applications must be made in writing by completing a parking permit for people with disabilities
application form.
2. Application forms can be submitted by mailing:
 A completed application form to Cardinia Shire Council, PO Box 7, Pakenham VIC 3810.
 Submitting it in person at Cardinia Shire Council Civic Centre, 20 Siding Avenue, Officer.
 Scanning and emailing it to mail@cardinia.vic.gov.au
3. Parking permits for people with disabilities are not renewed. A new application form (including
medical check performed by a medical practitioner/specialist medical practitioner or clinical
psychologist) must be completed before a new permit will be issued.
Proof of eligibility
4. Section 3 of the application form must be completed by a medical practitioner or clinical
psychologist within two months of the date of application.
5. Cardinia Shire Council reserves the right to request further information or documents to support this
application.
6. Cardinia Shire Council will reconsider any unsuccessful application if the applicant or their agent
(‘applicant’) seeks a second opinion from another medical practitioner or clinical psychologist as in
condition 4 above.
7. Cardinia Shire Council will only issue permits to residents of the Cardinia Shire Council.
8. Permit holders must not hold a current parking permit for people with disabilities issued by another
municipality or state.
Permit fees
9. No fee is charged for the issuing of parking permit for people with disabilities.
Permit expiry
10. The permit will expire on the date shown on the permit.
11. Parking permits for people with disabilities will expire:
i.
A minimum of three years from the date of issue for a significant permanent ambulatory or
intellectual disability.
ii.
Six months from the date of issue for a significant long-term ambulatory disability.
12. Permit holders may apply for a new permit up to two months before the expiry date.
13. Upon expiry, the permit holder must ensure the permit is destroyed.
Category one permits
14. To be eligible for a category one (blue) permit:
i.
A medical practitioner must confirm that the applicant has either an acute or chronic illness in
which minimal walking may endanger their health, or
ii.
A specialist medical practitioner or clinical psychologist must confirm that the applicant is an
extreme danger to themselves and others in a public place without assistance by a carer, or
iii.
a medical practitioner must confirm that the applicant has a significant ambulatory disability
and cannot access a vehicle in an ordinary parking bay, or they are required to use a complex
walking aid that prevents access to a vehicle in an ordinary parking bay.
Note: a complex walking aid is defined as an aid which has more than one contact point with
the ground.
15. A category one permit holder may park a vehicle in a parking bay reserved for people with
disabilities for the specified time limit only. This means a category one permit holder must not park
continuously in a parking area for people with disabilities for longer than the period indicated on the
sign. See Figures 1 and 2 below of a parking sign indicating that the parking bay is reserved for
category one permit holders.
16. A category one permit holder may also park a vehicle in any regular parking bay or area (to which a
green permissive parking sign applies for double the period indicated on the sign. See example 3
below for a permissive parking sign.
17. When selecting parking, permit holders must ensure a sign for a restricted parking area (indicated
by red signs) will not apply for any part of their intended stay. Any time allowed by a permit stops
when a red sign starts. Any extensions to parking time do not apply during the time a red sign is in
operation. For example, if a permit holder parks at 3pm and a clearway is due to commence at 4pm,
permit holders are not exempted past4pm when the clearway is in operation.
See Figure 4 below for a restrictive parking sign.
18. When electing to park for double the time shown on a permissive parking sign area:
i.
Required to pay the initial parking fee in meter areas, unless stated on the parking
meter, and
ii.
exempt from paying the initial parking fee in areas requiring a ticket to be purchased.
19. For parking in other municipalities, Cardinia Shire Council recommends permit holders check
parking fees and requirements with the relevant council.
Category two permits
20. To be eligible for a category two (green) permit, a medical practitioner must confirm that an
individual has a significant ambulatory disability or severe illness which does not affect their ability
to walk, however they require rest breaks when continuous walking is undertaken.
21. A category two permit holder may park a vehicle in any regular parking bay or area (to which a green
permissive parking sign applies) for double the period indicated on the sign. See example 3 below
for a permissive parking sign.
When selecting parking, permit holders must ensure a sign for a restricted parking area (indicated
by red signs) will not apply for any part of their intended stay. Anytime allowed by a permit stops
when a red sign starts. Any extensions to parking time do not apply during the time a red sign is in
operation. For example, if a permit holder parks at 3pm and a clearway is due to commence at 4pm,
permit holders are not exempted past 4pm when the clearway is in operation. See Figure 4 below of
a restrictive parking sign.
When electing to park for double the time shown on a permissive parking sign, category two permit
holders are required to pay any initial parking fee that may be applicable. For example in a 1P (one
hour) meter or ticket parking area, category two permit holders may park continuously for two hours,
provided payment is made for the first hour.
22. Cardinia Shire Council recommends permit holders to check parking fees and requirements with the
relevant council.
A category two permit does not allow the permit holder to park in an area reserved for people with
disabilities (these parking areas are designated for category one permit holders only). See Figures 1
and 2 below of a parking sign indicating that the parking bay is reserved for category one permit
holder only.
Permit codes
23. Cardinia Shire Council may issue category one or two permits as follows:
i.
Code A – for a driver or passenger who has a significant permanent intellectual or ambulatory
disability that is not likely to improve in the person’s lifespan.
ii.
Code B – for a passenger who has a significant permanent intellectual or ambulatory disability
that is not likely to improve in the person’s lifespan.
iii.
Code C – for organizations transporting individuals with a disability (please refer to parking
permit for people with disabilities for an organization).
iv.
Code D – for a driver or passenger who has a significant ambulatory disability that is not
permanent, but is not likely to improve within six months.
24. Code B permits cannot be used if the driver is the permit holder.
Permit use
25. The permit must only be displayed when the vehicle is being used to transport the individual to
whom the permit was issued. It cannot be used if the permit holder is not travelling in the vehicle.
26. The permit must be securely displayed so all details remain clearly visible through the passenger
side of the front windscreen throughout the duration of parking.
27. Parking conditions and payment requirements can differ from one local council to another and a
permit holder should always check the applicable parking sign/s.
28. A member of Victoria Police or authorized Cardinia Shire Council officer may suspend the use of
parking bays in areas that have been designated for the use of this parking permit.
29. If any permit is lost, stolen, damaged or otherwise rendered unusable, the applicant will be required
to submit statutory declaration, explaining why the permit must be replaced. Supporting
documentation must be submitted where possible.
30. Parking is not permitted in restricted locations such as, clearways, loading zones, no stopping, taxi
only areas, bus zones and residential permit zones.
Other conditions
31. Failure to adhere to this permit’s conditions of issue and use regardless of the permit holder’s
entitlement to the permit, may result in the permit holder incurring a parking infringement notice.
32. If the permit holder no longer satisfies the eligibility requirements, the permit will cease to be valid
and must be returned to Cardinia Shire Council.
33. Cardinia Shire Council reserves the right to cancel this permit at any time.
34. Cardinia Shire Council reserves the right to change the conditions of issue and use of this permit at
any time.
35. Any permit which is altered, copied, sold or reproduced in any fashion is void and of no effect. In
such cases, permits may not be replaced.
36. Any permit which is obtained as the result of providing false or misleading information is void and of
no effect. In such cases, the permit holder will be ineligible to obtain a permit for a period of 12
months from the date of notification.
Examples only
Figure 1.
Figure 3.
Parking permitted for double the
sign time
Figure 2.
Figure 4.
Parking not permitted in red
sign areas