National Disability Card Application Form

Apply for a Replacement / Spare Card
First Name of Cardholder *
Last Name of Cardholder *
E-mail *

Confirmation Email example@example.com

Cardholder's Date of Birth
Date of Birth of Cardholder

Day Month Year
Day of Birth: *
The day of the cardholder's birth eg 12.
Month of Birth: *
The month of the cardholder's birth.
Year of Birth: *
The year of the cardholder's person's birth.

Apply for a Replacement / Spare Card
Photo of Cardholder *

Cancel of

Address for Card Delivery
Address Line 1 *
Address Line 2
City/Town *
County
Post Code *

Apply for a Replacement / Spare Card
*

I agree to the Terms & Conditions found at https://www.disabilityid.co.uk/terms-and-conditions
*

I agree to the Privacy Policy found at https://www.disabilityid.co.uk/privacy-policy

Checkout:
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National Disability Card
£ 9.00

National Carers Card
£ 9.00

Carers Lanyard & Holder
£ 5.00

DisabilityID Lanyard & Holder
£ 5.00

Verified Invisible Disability Lanyard & Holder
£ 5.00

Face Covering Exempt Lanyard & Holder
£ 5.00

Subtotal

£ 0.00

Shipping

£ 0.00

Total

£ 0.00
Should be Empty: