TA03 – Student parking application form

Instructions:

Please complete and return this form to the Traffic Office (Geological Sciences Extension Building) if you wish to apply for a student parking disc (use Tab or arrow keys to move between fields).

Traffic Office hours (Monday – Friday): 08h30 to 15h30

For Office Use Only
Paid / R / Cheque / Cash / Credit Card / Debit card
Date / Disc Number / Residence Number
Vehicle details
Vehicle registration number / Registered owner of vehicle / Address of owner
E.g. / CA 123 456 / Mr A. Car / ICTS on Main, Mowbray, 7700
1
2
3
Vehicle make / Colour
1
2
3
Student details
Student registration No / Name of Residence
Type of disc required / Unmarked Bays on all Campuses / Other (please specify)
Title / Print names in full
Course Study / Year of first registration at UCT
Have you attended any other University? / Yes / No / Where?
Campus / Upper / Middle / Lower / GSB / H. Hall / Med School
Local Residential Address
Post Code
Telephone number home / Office / E-mail / Cell
Agreement
I, the undersigned applicant, state that I am not a first year student of the University of Cape Town and hereby agree to abide by the rules and disciplinary regulations regarding parking on the University of Cape Town Property, and as amended from time to time. I swear that all given information is complete, true and correct. The disc is not replaceable.
I also confirm that I have read and understood the indemnity below.
Date: / Signature:

Note: All students please note that if you do not respond to your traffic tickets or summonses they will automatically be debited to your fee account.

Indemnity

UCT does not take any responsibility for the safe custody of any vehicle or articles herein, nor for any damages to the vehicles or articles, however caused, nor for any injuries to any person. All cars are left in all respects entirely at their owner’s risk.

05 July 2016 Page 1 of 1 TA03