CPFORM 4

2014/2015GREYHOUNDPARK ‘n’ RIDE APPLICATION

(To be read in connection with the Staff Car Parking Application Policy)

(Please indicate as applicable)New application Renewal

Please Use BLOCK CAPITALS (* Please circle as applicable)

* Prof/Dr/Mr/Mrs/Ms(first name) …………………………… (Surname)…………………………………………..

Position/Job Title ………………………………………………… Extension No ………… Bleep ……………….

Department/Ward ………………………………………………… Directorate…………………………………………

Floor……………………………………………………………… Wing………………………………………………..

E-mail address …………………………………………………@......

Vehicle RegNumber ……………………………………… Make of Vehicle ……………………………

  • The Greyhound Park N Ride Scheme is located at the Greyhound Stadium on Plough Road about ¾ mile from St Georges Hospital down Blackshaw Road towards Wimbledon. SW17 OBL
  • A minibus Service is available at peak times Mondays – Fridays 06.30 – 10:00 and again at 15:00 – 19:45 to convey staff between St Georges and the Greyhound Car Park. The service runs as a round robin on an approximate 15 minute round trip. The collection point is the Grosvenor Wing Bus Stop.
  • An Out of Hours Service is also available but this must be booked in advance with the Security Department on ext. 0044.
  • The user will be issued with a barrier key to operate the automatic barrier when in use; it is not transferable and the users will be charged £10 for the replacement of a lost or damaged key.
  • Please note that the Greyhound Stadium annually increase charges as of the 1st October.
  • Part time spaces are available but the full daily charge is applicable. You will be required to state

the days you require so the entry key fob can be activated for the necessary days. Please indicate this below:

Monday Tuesday Wednesday Thursday Friday

  • If you no longer require the use of the GreyhoundPark and Ride Service please give one (1) months notice in writing to Car Park Admin, Level 2, Lanesborough Wing.

Greyhound Parking Charges:

Monthly
1 DAY / £13.24
2 DAY / £26.49
3 DAY / £39.73
4 DAY / £52.97
5 DAY / £66.22

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I ……………………….Payroll Number ………………. agree to pay for car parking charges as outlined below:-

Initial charge to cover part month period:

Start date: .. ./ … / … to date: … / … / ... amount £ ...:… to be taken on … /… /…

Then monthly by payroll:

Start date: …/ … / … to date: … /… / … amount £…:… monthly thereafter.

I understand that the Trust may change the sum I must pay only after giving one (1) month’s notice in writing. All deductions will be made by Payroll. (We no longer accept cheques for Trust employees). Non-trust or SGUL personnel that meet the criteria above are required to complete a standing order mandate before a permit is issued.

The information above is, to the best of my knowledge, correct at the time of application. I agree to abide by the

Terms and Conditions laid down in the Staff Car Parking Application Policy (Copy available on the St.Georges Hospital Intranet)

Signed ………………………….………………………………Date: …. / …. / 20……

For Office Use Only: Key Fob No: …………………… Date of Issue: … / … / 20…