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Digital exclusion survey

Help us understand Digital Exclusion in Barking & Dagenham – take part in our survey for your chance to win a £100 shopping voucher!

More information

Your details

First name

Last name

Phone number

Email address

Your address

Address

Address line 1

Address line 2

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Postcode

Do you have a Freedom Pass?

Yes, elderly person's

Yes, disabled person's

No

Do you have a Blue Badge?

Yes

No

Your date of birth

Is this your first application for a Taxicard?

Yes

No

Which band are you applying for?

Read more about the bands

Band A

Band B

Do you receive any of these allowances:

Disability living allowance high rate for mobility

Personal Independence Allowance 8 points or more for mobility

Attendance Allowance

None of the above

Your National Insurance number

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