Car Park Permit Application Form - Mole Valley District Council

WITH EFFECT FROM 1 st APRIL 2013Parking Department, Mole Valley District Council, Pippbrook, Dorking, Surrey RH4 1SJResidents Car Park Permit Application Form This form along with payment should be receivedat least 10 working days in advance of commencement date.DETAILS Please write in capital lettersNameAddressPostcodeContact Phone NumberCurrent Permit Number (if applicable)Vehicle Registration:□ I am a new customerModel:□ I am an existing customerExisting Permit Number_________________RESIDENT PERMIT REQUIREMENTSDuration of Permit Number Required PriceQuarterly Residential - £87.5012 Month Residential - £350TotalTown Please indicate which car parkwould be your first choice byplacing a 1 in the adjoining box anda 2 for your second choice.DorkingLeatherheadWe will endeavour to match your requirementsbut as the numbers of permits are limited wecannot promise a permit for your first choice ofcar parkSt Martins Walk Reigate RoadChurch StreetRandalls Road Station RoadAshtead Grove Road Ashtead PeaceMemorial HallMonth Of Commencement: 1 st .(Season Tickets commence on the first day of the month)Please see overleaf for more information regarding season ticketsI have read and understood the terms and conditionsSigned:Office Use OnlyDate ReceivedDate:Season Ticket Number(s):

WITH EFFECT FROM 1 st APRIL 2013Resident Permit InformationThe Residents Parking Permit is NOT VALID for use in any of the MVDC car parks that are not listedbelow.ONLY residents who live in the following streets are eligible for the discounted Resident Permit: Proofof residence will be required. No other streets are included in the scheme at this time.Dorking: Church Street, Myrtle Road, Meadowbrook Road, North Street.Leatherhead: Church Walk, The Crescent.Ashtead: Albert Road, Gaywood Road, Grove Road, Park Walk.PLEASE NOTE: THERE ARE A SMALL NUMBER OF INDIVIDUAL DEVELOPMENTSCOMPLETED BETWEEN APRIL 2006 & SEPTEMBER 2012 WHICH ARE ELIGIBLE FORRESIDENT PERMITS DUE TO NO PARKING PROVISION AT THE TIME OFCOMPLETION. PLEASE CONTACT PARKING SERVICES FOR DETAILS.• The purchase of a parking permit does not reserve a space and the council are unable toguarantee parking spaces.• Parking permits are limited and are issued on a first come first served basis. Once the limitedamount of permits has been issued, applicants will be placed on a waiting list and will benotified when a permit becomes available.• A parking permit will be valid for 12 months from the 1 April but may be purchased during theyear on a pro rata basis depending on the month of issue.• If, during the year, you wish to obtain a refund on the remainder of your permit, a refund will bebased on the amount of full months remaining in the year.• Resident permits are NOT valid in all Mole Valley Long Term car parks. The issued permit isonly valid in the ONE town that you have nominated on your application and is shown on thepermit.• A maximum of 2 vehicle registrations can be shown on each permit.• Reminders will NOT be sent at this time.Permits are ONLY valid in the following long-term car parks in the Mole Valley District CouncilArea:Dorking Permits: St Martins Walk (Long Term Section only), Reigate Road,Church Street.Leatherhead Permits: Randalls Road , Station Road (In the Permit Holder Only section).Ashtead Permits: Grove Road, Ashtead Peace Memorial Hall.Fair Processing Notice for Forms:This authority is under a duty to protect the public funds it administers, and to this end may use theinformation you have provided on this form for the prevention and detection of fraud. It may also sharethis information with other bodies responsible for auditing or administering public funds for thesepurposes.For further information, see www.molevalley.gov.uk/datasharing

Terms and ConditionsThe following terms and conditions are subject to review and as such, theCouncil’s current terms and conditions at the time of application will prevail.1. The permit must be displayed in the front windscreen of the vehicle so that itis clearly visible at all times.2. Annual and resident permits may be used in any of the Council’s long termPay & Display car parks in your nominated town.3. The permit is not transferable between vehicles unless prior arrangement ismade.4. Reminders regarding renewal of permits will not be sent, and renewalapplications must be received at least 10 days of the commencement date toguarantee sufficient time for processing and dispatch.5. Some of the council’s car parks have a maximum stay of 3 hours parking, andany short term parking restrictions must be adhered to.6. Failure to display a permit will result in a Penalty Charge Notice being issued.7. A permit does not guarantee a parking space.8. The council reserves the right to refuse issue of a permit.9. If a permit has not been used in accordance with the terms and conditions,the Council reserves the right to withdraw the permit.10. The permit may only be used for motorcars licensed as private or goodsvehicles not exceeding 6’6” in height.11. The terms and provisions of the council’s current off-street parking order areimplied in this agreement.12. Refunds can be obtained on full calendar months only, original permit mustbe returned and an administration charge will apply.13. Any omissions of information may result in a delay in the issue of a permit.The application will not be processed if not signed and dated. Photocopies ofapplications cannot be accepted as we can only process application formswith an original signature.