[jaws-uk] Disabled persons rail card application form
- From: "andrew shipp" <andrew-shipp4@xxxxxxxxxxxx>
- To: "access-uk" <access-uk@xxxxxxxxxxxxx>
- Date: Sun, 19 Nov 2006 14:16:44 -0000
Hello All, I do apologise for the cross posting but I am trying to find out
from as many people as possible if this new Disabled person rail card for is
accessible to all, If anyone has any problems with this form please make a
note of the problem and send it to me so I can send a copy to the
appropriate people. For those of you that don't know, I tried to apply
for one of these the other week and found the form online not accessible,
so this posted here below is what they are proposing to do in text format.
OFFICE USE ONLY
No DP
Day Month Year
DISABLED PERSON'S RAILCARD APPLICATION FORM
Please complete the appropriate sections and click on the boxes to mark
them.
* = delete as applicable
** = please type in required information
I wish to apply for my FIRST Disabled Person's Railcard
I would like a Disabled Person's Railcard that lasts for one year and costs
£18.00 (Y/N*)
I would like a Disabled Person's Railcard that lasts for three years and
costs £48.00 (Y/N*)
My title is (Mr, Mrs, Rev etc.) **
My initials are **
My date of birth is **
My surname is **
My full postal address is **
My post code is **
My daytime telephone number is **
My email address is **
Please enclose a cheque or postal order made payable to "RSP Ltd (DPRC)" or
give us your credit, debit or charge card details below. WE accept payments
by Visa, Delta, Mastercard, Switch Maestro, Amed and Rail Warrant.
Unfortunately we cannot accept Visa Electron cards (Please do not send us
cash).
My card is a Visa/Delta/Mastercard (Y/N*)
AMEX (Y/N*)
Switch (Y/N*) Issue number **
Rail Warrant (Y/N*)
My card number is **
Expiry date **
The name on the card is **
1 So train companies can send you a reminder shortly before your Disabled
Person's Railcard is due to run out, we will need to store your details on a
computer. If you do not want to receive a reminder please delete 'N' here
(Y/N*)
2 Train companies may want to understand more about their Disabled Person's
Railcard holders and may, sometimes, use information from the mailing
database (for example, regions where railcard holder live) to help them to
improve facilities for disabled people. Sometimes the train companies may
appoint agencies to get the valuable opinions of railcard holders by asking
them to take part in surveys. If you do not want to take part in these
surveys, please delete 'N' here: (Y/N*)
3 From time to time, we may want to allow companies to send you details of
produces or information we think you may be interested in. Please delete 'N'
here if you would not like to receive this information. (Y/N*)
I have read, understood and agree to the Conditions of the Disabled Person's
Railcard. The details I have given are correct.
Signed ____________________________________________________
Date _**_______________________________________________
If you would like a Braille sticker on your Railcard or Railcard wallet,
please check one of the boxes below:
Railcard (Y/N*)
Railcard wallet (Y/N*)
Why do you qualify for a Disabled Person's Railcard?
(Please mark appropriate box and enclose the proof we ask for with our
application form)
Box 1
Social Services Stamp
I am registered blind or partially sighted: **A
(Ask Social Services to certify your application form by
Putting their official stamp in Box 1 opposite)
I am registered deaf: **B
(Ask Social Services to certify your application form by
Putting their official stamp in Box 1 opposite or enclose your
NHS hearing-aid battery book)
I have epilepsy and still have fits even though I take medication for this:
**C If you have ticked this box, please enclose the following:
a.. A copy of your exemption certificate, which allows you to receive
medication for your condition free of charge
b.. Your customer copy of your prescription, or a photocopy of your
prescription for your epilepsy medication containing one or more of the
following drugs or their equivalent
Lorazepam, diazepam, clonazepam, phenytion sodium, fosphenytoin,
phenobarbital sodium, clomethiazole, paraldehyde and other medications in
line with the National Society for Epilepsy guidelines.
I receive
Attendance Allowance (please enclose a copy of your award letter) **D
OR
Disability Living Allowance **E
(at the higher rate or lower rate for help with getting around (mobility)
for one year or longer or at the higher or middle rate for help with
personal care. Please enclose a copy of your reward letter)
OR
Severe Disablement Allowance **F
(please enclose a copy of your award letter)
Long term incapacity benefit **G
(please enclose a copy of your award letter)
I receive
War Pensions Mobiltiy Supplement **H
(please enclose a copy of your award letter)
OR
A War or Service Disablement Pension for 80% or more disability **J
(please enclose a copy of your award letter)
I have bought or leased a vehicle through the "Motability" Scheme **K
(please enclose a copy of the leasing or hire-purchase agreement)
How do you want to receive your renewal notices?
(please delete 'N' from one box only)
I need these as:
Standard letter (Y/N*)
Braille (Y/N*)
Large print (Y/N*)
Audio tape (Y/N*)
Audio CD (Y/N*)
Now print this form, sign it and send it with your proof of qualification
and payment to: Disabled Person's Railcard Office, PO Box 163,
Newcastle-upon-Tyne NE12 8WX.
Thank you.
Regards
Andrew Shipp
Located Northampton Northamptonshire UK
Home phone...+44]0,1604 517007
Mobile 07983598287
Skype name...andyshipp55
Ham callsign M 0 C E G
Echolink node 220344
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