Please complete all sections before submitting your application.
We have a duty to protect the public funds we administer and may use the information you have provided on this form to prevent and detect fraud. We may also share this information with other bodies responsible for auditing or administering public funds for these purposes.
For more information, go to www.dacorum.gov.uk/dataprotection.
Type of bays and restriction
If your application is approved, we will send a confirmation email to you within five to seven days, with details on how to pay.
I declare that all the information I have given in this application is correct and understand that a false statement or any breach of the above may result in the withdrawal of the dispensation and render me liable for prosecution.
By submitting this form, you are in agreement with our parking dispensation terms and conditions.