Parking permit application Resident, foreshore, combined and visitor parking permit

Only residents of the City of can apply for a permit. Please tick to confirm I am a resident of the property listed on this application. I have supplied the required identification with my permit application.

Resident details Please write clearly in CAPITAL LETTERS.

Given names Surname Residential address

Suburb Post code Mailing address

Contact number Mobile Home Business Date of birth Email

Permit/s required A maximum of three (3) permits will be issued per property (this can include a maximum of two (2) visitor permits). Permit number (Office use only) Permit 1 Resident Foreshore Combined Visitor*

Vehicle registration State Permit number (Office use only) Permit 2 Resident Foreshore Combined Visitor*

Vehicle registration State Permit number (Office use only) Permit 3 Resident Foreshore Combined Visitor*

Vehicle registration State * no vehicle registration required for visitor permits

Parking permit fees Concession card holders are entitled to obtain one permit free of charge Permit type Fee and subsequent permits at half price. This applies to holders of one of the following cards: Resident permit $83 • Pensioner Concession Card – issued by Centrelink, Department of Human Foreshore permit $61 Services or Department of Veterans’ Affairs. • Health Care Card issued by Centrelink or Department of Human Services. Combined permit $122 • Commonwealth Seniors Health Card issued by Department of Human Visitor permit $112 Services. • Department of Veterans’ Affairs (DVA) Gold Card – War Widow (WW) or Totally and Permanently Incapacitated (TPI). To receive the reduced fee, a copy of a current concession card, in the applicant’s name, must be provided with the application. Parking permit application

Identification checklist All applications require one (1) piece of residential identification. All applications for a resident, foreshore or combined permit must also submit one (1) piece of vehicle identification.

Residential identification Document must specify the applicant’s name and current address. Rates notice (mailing address on this notice must match the application address) Current residential lease bond receipt* Drivers licence

Bank statement* Utility bill (gas, electricity, telephone)* Correspondence from an official government department. For example: • Pension card • Seniors Heath Care card • Australian Tax Office • Electoral Role Verification • Centrelink • Medicare

Vehicle identification Document must specify the applicant’s name, current City of Port Phillip address and vehicle registration number.

Vicroads: • Current vehicle registration certificate • Change of address notice • Transfer of registration

Traffic infringement letter / notice Current vehicle insurance certificate/Policy document Letter from company to confirm company vehicle or lease company if leased privately**

CityLink letter / account notice* Licensed motor car trader sale contract for vehicle

* Identification document must be fewer than eight (8) weeks old. ** Letter from employer (on official letterhead with ABN and signed by a Company Director/Fleet Manager) must confirm applicant has primary use of the company owned vehicle and confirm the overnight garaging address. If you are self-employed, please also include a copy of the vehicle insurance certificate OR the vehicle registrationcertificate in the company name.

Declaration

I declare that I am a permanent resident at the stated address and that the information Signature I have provided is true and correct. I agree that I have read and understood Council’s parking permit conditions and information and wish to apply for the selected permit/s to use in accordance with these terms and Council’s parking permit policy. I will ensure that the permit/s are not sold, transferred or assigned to another party and will be Date solely used for residential purposes. I agree to return the permit/s to Council if my eligibility or place of residence changes. I understand that all parking permit fees are non-refundable.

Applications with required identification documents and payment can be submitted: Further information In person: St Kilda Town Hall, South Please contact ASSIST via: www.portphillip.vic.gov.au/contact_us.htm Town Hall or Phone: 03 9209 6777 Website: www.portphillip.vic.gov.au Port Privacy Post: Private Bag No 3, PO St Kilda, The personal information requested on this form is being collected by Port Phillip City Council to assist in the VIC, 3182 assessment of your parking permit application. The personal information will be used solely by Council for that primary purpose or directly related purposes. Council may disclose this information to VicRoads and Victoria Online: Applications can also be Police. If this information is not collected, Council will be unable to assess your parking permit application. completed at www.portphillip.vic. The applicant understands that the personal information provided is for the assessment of the parking permit gov.au/parking_permits. application and that he or she may apply to Council for access to and / or amendment of the information. Requests for access and / or amendment should be made to Council’s Governance department.