I declare that the information provided in this application is complete, true and correct in every detail.
I authorise the collection of the information on this form, where it is personal information under the Privacy Act 1993, for the use of CCS Disability Action and its branches, and in relation to the Mobility Parking Permit scheme. Under the privacy Act 1993, where CCS Disability Action holds my personal information in such a way that it can readily be retrieved. I understand I am entitled to have access to that information and I can request the correction of that information.
I agree that for the operation, administration and enforcement of the terms of mobility parking this information may be passed on to the Ministry of Transport and city and district councils and their parking enforcement agents
I agree to abide by the conditions of use of the Mobility Parking Permit as outlined on the Mobility Parking website