DISABLED PERSON'S RENEWAL FORM

Please read the notes overleaf and guidance on proof of disability before you return this form.

NoWCARD SERIAL NUMBER

633597 _ _ _ _ _ _ _ _ _ _ _ _

NoWCARD EXPIRY DATE

_ _ / _ _ _ / _ _ _ _

FIRST NAME/S (Full name not initials)

SURNAME

ADDRESS

POSTCODE

DATE OF BIRTH (DD/MM/YYYY)

_ _ / _ _ / _ _ _ _

TELEPHONE NUMBER/S

EMAIL ADDRESS

DISABILITY (Please tick your disability, please see guidance)

���� Sight ���� Hearing ���� Speech ���� Learning ���� Arms ���� Walking ���� Driving

Driving reason:______________________________________________________

I confirm that the details above are correct and that this is my sole or principal residence.

Signature Date ________________________________ ________________

ATTACH RECENT

PHOTOGRAPH HERE

Before you return this form, please check the follo wing.

• Are you resident in Lancashire? If not please apply to your local authority for a pass.

• If your current pass is issued by an authority other than Lancashire you should

complete a new application form.

• If your pass expired more than 12 months ago you should complete a new application form.

Have you enclosed?

• A new photograph? The photograph must be a recent (taken within the last 6 months) passport style and quality colour photograph, it should have a plain, pale background and you must not be wearing sunglasses or headwear (exceptions will be made on religious or medical grounds but your full face must be visible).

• Proof of disability? Please see guidance attached.

• Proof of your residence? This can be a photocopy of a recent (dated within

the last 3 months):

o Bank statement (delivered to you by post). o Utility bill (delivered to you by post). o Council tax bill (current year).

• If you have changed your name since your last pass was issued you will need

to enclose a copy of proof of name change e.g. marriage certificate or deed poll.

� Please return your form by post.

You must ensure the correct postage is paid when you return your form; failure to pay the correct postage may result in the non-delivery of your application The address the form and any accompanying documents should be returned to is: This is a postal address only; you cannot attend in person. NoWcard Disabled Renewal PO Box 100 County Hall PRESTON PR1 0LD