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IWA’s Online Parking Permit Section

First Name

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Email

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Last Name

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Address Line 1

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Date of Birth

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Address Line 2

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Mobile Phone

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Address Line 3

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Home Phone

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County

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Eircode

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Lead Ref No

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Name of Applicant's General Practioner

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Address of Applicant's General Practitioner

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Contact Number for Applicant's General Practitioner

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Form Processing

How would you like to receive a copy of this form?

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GDPR Consent

I consent to the collecting and processing of my personal data for the purposes outlined

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If signing on behalf of applicant, please enter your name in the textbox:

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Primary Medical Card Holder

Primary Medical Card Holder NoPrimary Medical Card Holder Yes

Registered Blind

Registered Blind NoRegistered Blind Yes

Certified Blind

Certified Blind NoCertified Blind Yes

Use Wheelchair

Use Wheelchair NoUse Wheelchair Yes

Mobility Restrictions

Severe Respiratory or Lung Disease

Severe Respiratory or Lung Disease NoSevere Respiratory or Lung Disease Yes

Regular Oxygen Use

Regular Oxygen Use NoRegular Oxygen Use Yes

Use Walking Stick

Use Walking Stick NoUse Walking Stick Yes

Use Rollator

Use Rollator NoUse Rollator Yes

Use Frame

Use Frame NoUse Frame Yes

Use Crutch

Use Crutch NoUse Crutch Yes

Other Visual Impairment

Other Visual Impairment NoOther Visual Impairment Yes

Use Other Mobility Appliance

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Can Walk Unaided

Can Walk Unaided NoCan Walk Unaided Yes

Distance Walk Unaided

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First Time Application

First Time Application NoFirst Time Application Yes

Origin of Application

First Time Applicant - Documentation Required with Application

Primary Medical Cert Holders applying for a Permit for the first time are required to provide a completed Permit application form along with the following:

- A passport sized photo of the applicant i.e. the person with the disability or medical condition.

- Fee of €35 (plus an additional €2 if you wish to purchase a Parking Permit holder) by cheque or postal order made payable to Irish Wheelchair Association

In addition to the above, applicants are required to supply one of the following documents

i) A copy of their Primary Medical Cert issued by the HSE

OR

ii) A copy of their Vehicle Registration Cert which indicates that they are entitled to avail of the Disabled Drivers & Disabled Passengers Tax Relief Scheme.

Please forward completed application form and supporting documentation to Irish Wheelchair Association, PMC Section, Ballinagappa Road, Clane, Co Kildare W91YT99

You have selected Registered Blind

You will need to provide IWA with the following:

- Applicant will be required to submit evidence that they are registered with the National Council for the Blind or will be required to submit certification from a General Practitioner, Ophthalmologist or Optician which indicates that they meet the blind registration criteria.

- A passport sized photo of the applicant i.e. the person with the disability or medical condition.

- Payment of the application fee of €35 (plus an additional €2 if you wish to purchase a Parking Permit holder) by cheque or postal order made payable to Irish Wheelchair Association

- Applicant will be required to submit evidence of their registration with NCBI.

You have selected Certified Blind

You will need to provide IWA with the following:

- Applicant will be required to submit evidence that they are registered with the National Council for the Blind or will be required to submit certification from a General Practitioner, Ophthalmologist or Optician which indicates that they meet the blind registration criteria.

- A passport sized photo of the applicant i.e. the person with the disability or medical condition.

- Payment of the application fee of €35 (plus an additional €2 if you wish to purchase a Parking Permit holder) by cheque or postal order made payable to Irish Wheelchair Association

- Applicant will be required to submit evidence of their registration with NCBI.

- Applicants must have their General Practitioner certify that they meet the medical criteria for the Disabled Parking Permit.

- A passport sized photo witnessed by An Garda Síochána of the applicant i.e. the person with the disability or medical condition.

- Payment of the application fee of €35 (plus an additional €2 if you wish to purchase a Parking Permit holder) by cheque or postal order made payable to Irish Wheelchair Association

In order for your application to progress without delay, please send these documents by post to : Irish Wheelchair Association, Parking Permit Section, Ballinagappa Road, Clane, Co Kildare.

I agree to supply the documentation noted above

Irish Wheelchair Association
Registered Office: Áras Chúchulainn, Blackheath Drive, Clontarf, Dublin 3, Ireland.

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