Blue Badge Scheme - Application Form For an Individual
This form is for completion by the residents of Staffordshire. If you live in the Stoke-on-Trent area, you should contact Stoke-on-Trent City Council to apply for your Blue Badge.
 

You are advised to read the guidance notes for completing this form (please click the guidance notes link).  If you need to download the software to read the notes please click the link to  get the free Adobe Reader.

 
Applicants for an organisational badge should click the link to complete a different form.
   
To apply for a Blue Badge for an individual please complete the sections of this form as they appear on the screen.   At the end of this form you are required to complete the declaration and click on the 'Finish' button.  You will then see a submission reference which you should note for your future use.
   
Section A
 
Personal details of the applicant
   
   
*
 
*
 
*
 
*
 
*
   
*
Letters Numbers Letter
 
(National Insurance numbers start with two letters, followed by six numbers then another letter.)
OR
 Please tick this box if the applicant is a child too young to have a National Insurance No.
 
*
 
Current Address  
   
*
 
*
 
*
 
*  (e.g. ST1 1AA)
 
   

Confirmation of Address

You will later be asked to supply a copy of one of the following:

 - Utility bill
 - Rent book
 - Council tax bill

Whichever one you provide, it must contain a date within the last three months to show that you are living in the county/borough.
   
   
Previous Address (if different in the last three years)
   
 
   
 
 (e.g. ST1 1AA)
 
   
Telephone and Email  
   
   
 
 
Renewals Only  
   
   
Date:
   
 
*
 
 
 
*
 
  (One number should be nominated but other vehicles may be used and the badge transferred when necessary.)