Parking Services
Staff Permit Cancellation
Completed forms must be returned to the Welcome Centre, 423 University Crescent by the last business day of the
current month, in order to be effective for the following month. See full Terms and Conditions below.
Customer Information (all fields required)
Name:
Mailing address:
City: Postal code:
Employee I.D #:
Permit Information
Virtual Permit/ Permit #:
Location:
Cancellation date:
Reason for cancelling:
Permit Cancellation Terms & Conditions
I authorize Parking Services to cancel the Staff Parking Permit and understand that in order for cancellation to take effect for the upcoming
month, I must surrender the staff permit (if applicable) and submit it to Parking Services along with this form by the last business day
of the current month. No refunds will be processed for cancellations submitted mid-month.
I understand that Parking Services will cancel the permit agreement within 30 days if the permit cancellation form is not accompanied by
the hang-tag (if applicable). I understand Parking Services will automatically cancel my waitlist request(s) unless I request to remain active
on the waitlist. I understand if the permit is being returned under the Parking Leave Option on this form, I may not receive immediate
direct entry in my preferred lot upon my return.
Notice Regarding Collection, Use, and Disclosure of Personal Information by the University
Your personal information is being collected under the authority of The University of Manitoba Act. The information you provide will be
used by the University for the purpose of cancelling the parking permit including any existing Pre-Authorized Debit Agreements and
waitlist requests, as well as issuing a refund (if applicable). Your personal information will not be used or disclosed for other purposes,
unless permitted by The Freedom of Information and Protection of Privacy Act (FIPPA). If you have any questions about the collection of
your personal information, contact the Access & Privacy Office (tel. 204-474-9462), 233 Elizabeth Dafoe Library, University of Manitoba,
Winnipeg, MB, R3T 2N2.
Parking Permit Leave Option
Only complete this section if you are requesting to defer your parking due to an approved U of M leave.
Vacation does not qualify as an approved leave.
Temporary Cancellation and Preferential Waitlist Application
A signed Cancellation Form is returned to Parking Services. No further payments are required, until the staff member is
back to work and assigned a new permit. This is a cancellation and is in effect until Parking Services is notified of the
customers return, by the customer. Upon return to work, the staff member is eligible to have their name placed near the
top of the waitlist for their original lot. If the lot is full, Parking Services may place the staff member into a different lot
until their preferred lot is available.
I confir
m this is an approved leave: Return to work date:
INITIAL MM/DD/YYYY
SIGNATURE INDICATES UNDERSTANDING AND ACCEPTANCE OF ALL OF THE ABOVE TERMS AND
CONDITIONS
Permit Holder Signature: Date:
VIRTUAL PERMIT/ PERMIT #:
RECEIVED BY: &
PAYMENT METHOD: DW or P/O
AUTHORIZATION FOR REFUND NO.:
TAXABLE BENEFIT: Y or N RECORDED: Y or N
DATE PERMIT RETURNED:
ADD or REMOVE W/L:
ORIG W/L REQUEST DATE:
REFUND AMT: (if applicable):
CANCELLATION COMPLETED BY:
