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02/2016

CENTRAL MILTON KEYNES - RESIDENT PAPER PARKING PERMIT/ SCRATCH-


CARD APPLICATION FORM
Please read guidance notes for assistance.
FOR OFFICIAL USE ONLY
Cheque S/C Numbers
Postal Order Date received Permit code
Debit Card Date issued Person code
Credit Card Processed by Permit check

Please note that a parking Permit/Scratch card does not guarantee the right to a parking
space. Permits are not transferable for example, for use in courtesy or borrowed vehicles.

A. Application Details
Mr/Mrs/Miss/Ms ______ Surname ____________________ Forename________________
Home Address ___________________________________________________________
________________________________________________________________________
________________________________________________________________________
Postcode ____________________ Daytime telephone number______________________

Your e-mail address________________________________________ (if you provide


this we will send an e-mail to remind you to renew your parking permit approximately 21
days prior to its expiry. However, you should note that the onus still rests with you to
remember to renew your permit. In the event you receive a Penalty Charge Notice (PCN)
as your parking permit has expired, non-receipt of an e-mail reminder will not be accepted
as a valid reason for failing to renew your parking permit and the PCN will be upheld)

B. Vehicle Details: Proof of vehicle ownership is required.


VRM _____________Make _____________Model_____________Colour___________
The vehicle registration document (VQ5) must show that the vehicle is registered to the
applicants address.

C. Proof of residency: Please provide copies of two of the following documents as


detailed in guidance note 4.
Driving Licence  Formal Tenancy Agreement  Medical Card 
Utility Bill  Pension Book  Bank Statement 

D. Permit Details: Please indicate below the type of permit applied for:

Resident Permit  Visitor Permit  Change of VRM  Replacement Permit 


Resident Visitor Scratch Cards (50 free per year) 

Additional Visitor Scratch cards: How many cards/books _____________ Chargeable at


£2.00 per card or £10.00 per book
E. Method of Payment (Please tick appropriate box)

 Postal Order (PO)  Cheque  Credit/Debit Card

Cheques and PO’s should be made payable to Milton Keynes Council. Please print
name, address and vehicle registration number on the reverse.
CREDIT CARD DETAILS: For your personal protection we are only able to process card
payments if you provide a day time contact number for the card holder, we will contact you
when we are ready to process your transaction.
Day time Contact Number _____________________________________________
Best time to call _____________________________________________

Postal Applications

Please allow 10 days for postal applications to be processed.

Send the completed application form and relevant documentation, detailed in guidance
note ‘A’, with payment (cash not accepted) to: Milton Keynes Parking, Suite 401,
Margaret Powell House, Midsummer Boulevard, Milton Keynes, MK9 3BN. Tel: 0845
2308855 option 3

By Email

Send the completed application form and relevant documentation to:


parkingpermitapplications@milton-keynes.gov.uk Tel: 0845 2308855 option 3.
F. Declaration to be signed by all applicants

I certify that I keep and or use the vehicle bearing the registration number stated in Part B.

I declare that I will return my permit/scratch cards to the Milton Keynes Parking address.
If I cease to keep and or use the nominated vehicle or I no longer reside in Central Milton
Keynes.

I undertake to inform the Council if any of the above has occurred.

I have read, understood and agree to be bound by the information provided in the guidance
notes.

I understand that failure to display a valid resident permit/scratch-card, in a resident parking


bay may lead to a Penalty Charge Notice being served.

I understand, subject to meeting criteria detailed in guidance note ‘1’, I am entitled to apply
for a resident permit/ resident scratch-cards.

I declare that all the information I have given in this application is correct and that I am not
in possession of a valid employee parking permit.

Signature ______________________________ Date _______________________

Data Protection
In order to provide services to you, we need to record your details, which you have a right
to see and check. Information may be shared with organisations we work with to provide
services to you. We will process and safeguard your details in accordance with the Data
Protection Act. Information may also be used in connection with the prevention and
detection of crime and fraud.

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