Replacement Card Application Form

Lost, Stolen, Damaged, or Spare Card Request
Please use this form to request a new card if your original has been lost, stolen, damaged, or if you need a spare copy.

This form is not for renewals. If your card has expired or is about to expire, please use the Renewal Form instead.
First Name of Cardholder*
Last Name of Cardholder*
E-mail*

Confirmation Emailexample@example.com
Phone Number*
In case we need to contact you about your application

Type of Card
What type of card are you replacing?*

National Disability CardNational Carers Card

Card Number
Do you know your Unique Card Number (UCN) of the card you are replacing?
It may be found in an email you received from us previously and should start with 'UK-
I don't know my Unique Card Number (UCN).

Card Number
Do you know your Unique Card Number (UCN) of the card you are replacing?
It may be found in an email you received from us previously and should start with 'UK-
I don't know my Unique Card Number (UCN).

Reason for Replacement
Why are you requesting a replacement card? Please select all that apply.*

Lost/Stolen/DamagedIncorrect Date of BirthIncorrect or Change of NamePhoto Update RequiredI Require a Spare CardAdd/Update Emergency ContactI would like to renew my card as it has expired or is due to expire within the next two months.

Renew Your Card
If your card has expired or is set to expire within the next two months, please use the buttons below to renew your card:

Renew National Disability Card >

Renew National Carers Card >

Cardholder's Date of Birth
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.

Photo Update
Photo of Cardholder*

Cancelof
Where possible, your photo should:

• be facing forwards and looking straight at the camera

• have your eyes open and visible

• not have a head covering (unless it’s for religious or medical reasons)

• not have anything covering your face (unless for medical reasons)

• contain no other objects or other people (unless for medical reasons)

We understand that some circumstances may make these guidelines impractical, in which case simply provide the clearest photo you can.

Add or Update Emergency Contact
Your emergency contact's number will be stored in a QR code on the back of your ID card this allows quick access without needing a data connection or login in an emergency.

Please enter the phone number exactly as it should be called. If it is not a UK number please also include the country code (e.g., +353).
Emergency Contact's Phone Number:*
I have double-checked the accuracy of the emergency contact phone number provided. I understand that if the number is incorrect, or if I need to change it in the future, I will be required to pay an administration fee and complete a replacement card form.
I confirm that I have obtained consent from the individual whose phone number is listed as my emergency contact. They are aware and consent to their phone number being encoded onto the physical ID card in the form of a QR Code and understand that it cannot be altered. Additionally, they understand that this phone number will be stored in our secure database solely for the purpose of reissuing an ID card, should the need arise.

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:*

Replacement Card Fee

£10.00

Carers Lanyard & Holder

£5.00 Quantity

DisabilityID Lanyard & Holder

£5.00 Quantity

Verified Invisible Disability Lanyard & Holder

£5.00 Quantity

Face Covering Exempt Lanyard & Holder

£5.00 Quantity

RADAR Key

£6.75 Quantity

Extra CardIf you require a spare card in addition to your replacement card.

£10.00

Royal Mail Special Delivery Guaranteed by 1pm®Select this option if you require your order to be sent via Special Delivery. Cards ordered before 3.30pm Monday to Friday will be delivered next day before 1pm (this price is in addition to the £3.50 below). Please note if you order after 3.30pm your order will be sent the next working day.

£6.50

Subtotal

£0.00

Shipping

£0.00

Total

£0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty:

Lost, Stolen, Damaged, or Spare Card Request

Type of Card

Card Number

Card Number

Reason for Replacement

Renew Your Card

Cardholder's Date of Birth

Photo Update

Add or Update Emergency Contact

Address for Card Delivery

Apply for a Replacement / Spare Card