Applicant:

Initial(s) *

Insert

Surname *

Date of birth *

Street name *

House number *

Addition

Postal code *

Residence *

Phone number *

Email address *

Caregiver:

Initial(s) *

Insert

Surname *

Date of birth *

Street name *

House number *

Addition

Postal code *

Residence *

Phone number *

Email address *

License plate

Desired effective date

Select parking garage *
-Choose an option-Parking HoutpleinParking Garage Kamp
You must include the following attachments:
Copy of valid identification of the person being cared for;

Copy of valid identification of the caregiver;

Recent statement from family doctor, Centrum Indicatiestelling Zorg (CIZ) or other professional body showing
shows that the applicant is dependent on informal care. This statement should not be older than 2 months;

Copy of the Part 2 registration certificate of the car for which the permit is being requested.

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