Badge holder's details Title First name Surname Surname at birth Date of birth (dd/mm/yy) National insurance number Town of birth Country of birth Next Page Current address Address Line 1 Address Line 2 City County Postcode Country Address if different in last 3 years: Address Line 1 Address Line 2 City County Postcode Country Previous PageNext Page Home Phone number Mobile number Email address Are you completing this form for someone else? Please select Yes No Previous PageNext Page Your details First name Last name Your address Address Line 1 Address Line 2 City County Postcode Country Your phone number Your email address Previous PageNext Page Reason for replacement Change of address (please attached a certified copy of evidence)Change of name (please attach a certified copy of evidence)Error on badge issued Please state the details of the error, if applicable If you are requesting replacement of an old laminated style badge you must also enclose a passport style photo. Attach passport photo: Attach proof of name/address change: Previous PageNext Page If you're ordering a replacement badgeThe cost of a replacement badge is £10. You will receive a letter/email with details of how to make a payment to our Customer Service Centre.If you are changing your address onlyYou don't need to pay and you don't need to return your badge. Your existing Blue Badge will remain valid. If you need to return your old badge as you're changing your name or an error on the badgePlease post to:Hertfordshire Blue Badge TeamPO Box 153StevenageSG1 2STRead our privacy notice Consent Please tick here to confirm you have read, understood and accepted our privacy notice. Previous Page Submit