Application for an Accessible Parking Permit

full name
date of birth
signature

Documents that provide proof of all three elements of identity (full name, date of birth and signature)

Driver’s Licence, Enhanced Driver’s Licence or Ontario Photo Card - issued by the Government of Ontario (not expired more than one year)
Passport - Canadian or Foreign (not expired more than one year)
Canadian Citizenship Card with photo (issued prior to February 1, 2012)
Canadian Permanent Resident Card with signature
Record of Landing (Form IMM 1000)
Confirmation of Permanent Resident (Form IMM 5292)
Report Pursuant to the Immigration and Refugee Protection Act with photo (Form IMM 1442)
Student Authorization/Study Permit (Form IMM 1442)
Employment Authorization/Work Permit (Form IMM 1442)
Visitor Record (Form IMM 1442)
Temporary Resident’s Permit (Form IMM 1442) - formally Minister’s Permit/Extension of Minister’s Permit
Secure Certificate of Indian Status Card (issued on or after December 15, 2009, by Indigenous and Northern Affairs Canada)
Canadian Department of National Defence driver’s licence (Form DND 404)

Documents that can be combined to provide proof of all three elements of identity (full name, date of birth and signature) when shown together

Proof of full name and date of birth

Canadian Birth Certificate or a proof of birth document issued by a US jurisdiction
Canadian Permanent Resident Card without signature (issued after February 4, 2012)
Certified copy of Statement of Live Birth - issued by the Government of Ontario
US Passport Card

Proof of full name

Certified copy of marriage certificate - issued by the Government of Ontario

Proof of full name and signature

Certificate of Indian Status (laminated card issued by Indigenous and Northern Affairs Canada)

Proof of date of birth

Nexus Card and FAST/EXPRESS Card

Proof of signature

Driver’s Licence or Enhanced Driver’s Licence - issued by another Canadian or US jurisdiction
Ontario Health Card
Identity card issued by a Canadian or US jurisdiction (enhanced or non-enhanced)
Ontario Student Card with signature
Declaration from a Guarantor (Form SR-LD-40)
Canadian Department of National Defence (DND) Identity Card

*Seniors (80 years of age and older) can provide ID documents that are expired up to 10 years to prove full name, date of birth (DOB) and signature. The expired documents for this client group are considered valid identity documents.

**Canadian Veterans of any age can provide ID documents that are expired up to 10 years to prove full name, DOB and signature - when accompanied by a proof of veteran status document. The expired documents for this client group are considered valid identity documents.

The following pieces of identity meet all three requirements for Seniors 80 years of age or older and Veterans:

Passport - Canadian (expired up to 10 years)
Passport - Foreign (expired up to 10 years)
Canadian Citizenship Card with photo (issued prior to February 1, 2012)
Canadian Permanent Resident Card with signature
Record of Landing (Form IMM 1000)
Confirmation of Permanent Resident Form (IMM5292)
Report Pursuant to the Immigration and Refugee Protection Act with photo (IMM 1442)
Student Authorization/Study Permit (Form 1442)
Employment Authorization/Work Permit (Form 1442)
Visitor Record (Form 1442)
Temporary Resident’s Permit (IMM 1442) - formally Minister’s Permit/Extension of Minister’s Permit
Secure Certificate of Indian Status Card (issued on or after December 15, 2009, by Indian and Northern Affairs Canada)
Driver’s Licence or Enhanced Driver’s Licence or Ontario Photo Card-issued by Ontario (expired up to 10 years)
Canadian Department of National Defence Driver’s Licence (DND 404) (expired up to 10 years)
Ontario Photo Health Card (Valid)

Cannot walk without a brace, cane, crutch, lower limb prosthetic device or similar assistive device or requires the assistance of a wheelchair or the assistance of another individual.

Suffers from lung disease to such an extent that his or her forced expiratory volume in one second is less that one litre.

Portable oxygen is a medical necessity.

Suffers from a cardiovascular disease to such an extent that the individual’s functional capacity is classified as Class III or Class IV according to Nomenclature and Criteria for Diagnosis of Diseases of the Heart and Great Vessels.

Severely limited in the ability to walk due to arthritic, neurological, musculoskeletal or orthopaedic conditions.

Visual acuity is 20/200 or poorer in the better eye with corrective lens, or whose maximum field of vision using both eyes has a diameter of 20 degrees or less.

Mobility is severely limited by one or more conditions or functional impairments.

I solemnly declare that the information made in this application is true and understand that any false statements will be forwarded to the relevant law enforcement authority for investigation of an offence under the Criminal Code and the Highway Traffic Act, and could result in the cancellation of my permit, a fine and/or imprisonment. Under the Highway Traffic Act, it is an offence to fraudulently obtain an Accessible Parking Permit and any person who contravenes the Act may be liable for a fine of up to $5,000. I authorize the release of health information for the completion of this form to ServiceOntario.

In addition, do you authorize the Ministry of Health (MOH) to disclose information about you from MOH's database consisting of full name, residential address, date of birth, sex and death status in order to verify the information provided on this form and that, for the purpose, ServiceOntario is obtaining your consent on behalf of the MOH.

If you have questions about the collection, use and disclosure by ServiceOntario of your the personal information provided in accordance with this application by ServiceOntario, please contact: Team Manager, ServiceOntario Contact Centre, PO Box 105, 777 Bay Street, Toronto ON M5G 2C8. Telephone: 416-235-2999. Toll free: 1-800-387-3445. TTY Toll free: 1-800-268-7095.

Confirmation: (required)

I have read and agree to the Declaration and have read, agree and consent to the Collection and Use of Information as stated above.

I do not agree and consent.

Date:

Summary

Note: To make changes to the information below, click the "Make Changes" button (at the bottom of this page) to access previous pages to make corrections.

Part A – APP Information

Current Permit Number:

Current Identification Number:

Type of application:

Part B – Applicant Personal Information

Last Name:

First Name:

Middle Initial:

Date of Birth:

Gender:

Telephone Number:

Email Address:

Residential Address:

Apt. / Unit Number:

Street Number:

Street Name:

City, Town or Village:

Province:

Postal Code:

Part D – Declaration, Collection and Use of Personal Information

I have read and agree to the Declaration, and consent to the Collection and Use of Information:

Declaration

Collection and Use of Information

Do you understand and consent to the collection, use, and disclosure of personal information in this application by ServiceOntario for the proper issuance, renewal, or replacement of Accessible Parking Permits and to administer the Accessible Parking Permit Program under the authority of section 2 (1) of O. Reg 581 under the Highway Traffic Act, R.S.O. 1990, c H.8? ServiceOntario may verify the information provided on this application form with health practitioners, jurisdictions, or other ministries to determine whether to issue, renew or replace the Accessible Parking Permit.
In addition, do you authorize the Ministry of Health (MOH) to disclose information about you from MOH's database consisting of full name, residential address, date of birth, sex and death status in order to verify the information provided on this form and that, for the purpose, ServiceOntario is obtaining your consent on behalf of the MOH.

This person is the:

Date:

Attachment(s)

Attachment 1

File:

Attachment Description:

File Size (MB):

Total File Size (MB):

Acceptable Identification

To complete the online application, you will need to:

Regulated Healthcare Practitioners

Authorized Representative

Occurrence Number

Traveller’s Permit

Motorcycle Decal

Motorcycle VIN number

To complete your online application, you must have:

Gender X

Residential Address

Declaration

Collection and Use of Information

Unable to Proceed: