Fillable Parking Permit Application Form printable pdf download

Office Use Only:

Property and Facilities Division

Form

Permit No.

03/08/16

Parking Permit Application Form

PF01

For information on Parking @ UQ, permit terms & conditions, fees and charges, please visit:

1. PERMIT TYPE - YOU MAY ONLY SELECT ONE PERMIT TYPE FROM THIS LIST

Permit Type :

Click on drop down arrow to select Permit Type

* If you have selected Part-time or Special Need Parking Permit from the drop-down list above, please also select the days of the

week you wish the permit to be valid. A part day is treated as a full day.

Mon

Tues

Wed

Thurs

Fri

Request for Special Consideration – please detail:

2. APPLICANT DETAILS

(if insufficient address or vehicle details are supplied the form will be returned to applicant for completion)

UQ Staff No.

Student No.

(UQ staff only, if applicable)

(if applicable)

Surname

First Name

Title

UQ Org Unit/

UQ Building

UQ Room No

Business Name

Postal Address

Mobile

Telephone

Vehicle Reg. No.

Make (e.g. Ford, Holden, Toyota)

Permit commencement date

Permit expiry date

(only specify if purchasing a short-term permit)

(Minimum permit length is 4 weeks)

The University does not accept any responsibility for the (1) loss or damage to any vehicle; or (2) loss or damage to any article or thing, in or upon any vehicle or for any

injury to any person, howsoever such loss, damage or injury may arise, including by way of negligence by the University.

Restrictions apply to permit alterations. Please contact PF Assist for further information.

Signature of Applicant: ………………………………………… Date:

3. PAYMENT DETAILS - SELECT ONE PAYMENT TYPE

(where applicable)

- Complete this section if you wish to pay for permanent parking by regular deductions from your salary

PAYROLL DEDUCTION AUTHORITY

(only permanent UQ staff are eligible for salary deductions – this option is not available for casual staff or for the Gatton Undercover Car

park). Payroll deductions for parking will automatically be salary packaged

Staff No

Surname

Initials

School/Section

I authorise The University of Queensland to deduct from my salary the amount payable. The amount is to be deducted in regular fortnightly instalments. I agree

that unless I return my parking permit before ceasing employment, the University of Queensland may deduct from monies owing to me (including salary or

wages) the difference between the amount I would have paid for permanent parking if I had not had payments deducted from my salary and the sum of the

deductions from my salary for the year in question. A part fortnight is charged as a full fortnight. Permit holders who pay via fortnightly payroll deductions can

only request for their payroll deductions to be ceased whilst on leave if the period of leave is 3 months or greater.

Signature of Applicant: ………………………………………… Date:

CREDIT CARD PAYMENT AUTHORITY

CASH * /CHEQUE/ MONEY ORDER/EFTPOS

Please charge $

towards my:

Mastercard

Visa Card

Surname:

Card holder name:

Initials:

Card No.