BUS PASS APPLICATION FORMAT

FREE SUPPLY

APPLICATION FOR STUDENT BUS PASS

( RTC-282/R )

ANDHRA PRADESH STATE ROAD TRANSPORT CORPORATION PHOTO

1. NAME OF THE STUDENT (Maximum 20 Characters): Name Surname

2. Father’s/Mother’s Name: (Maximum 20 Characters): Name Surname D D

M M

Y Y Y Y 4. Sex :

3. Date of Birth: 5. Type of Pass : 7. Institution Code: 8. Course Code :

M

F

6. Bus Pass Code : Institution Name:

Course Name:

9. Admission No. : 10. Route Particulars: From

To

Via 11. Residential Address : H.No. Street Village Mandal District Pin Code Cell No. I hereby declare that the particulars given above are true and correct. I will abide by the rules & regulations of APSRTC governing issue of Bus Passes. Signature of the Candidate.

BONAFIDE CERTIFICATE I hereby certify that Sri / Kum / Smt. …………..……………………………….…………………… is a bonafide student of ……………………………………………………… (Name of the institution) studying ……….………….. (Name of the course) with Admission No ……….………….…….. & Roll No ……….……………. His / Her Date of Birth is ………...…………….. (DD/MM/YY) as per office records and the course will be completed by ……………………………. (DD/MM/YY). Educational Institute Recognition Code No ………………………. (As per the D.E.O. records). Course Code No …..….………… for the Academic year …..…………..…… Date: Place:

Signature of Head of the Institution with Seal.

Page - 2

For Office Use Only DD

MM YY

Receipt Date:

M.R. No./Ack.Receipt No:

Bus Pass ID No. Bus Pass Ticket No:

Pass Amount Rs.:

Route Code : Pass Issued at :

Route Kms.:

Signature of the Issuing Authority. Name: Design: Date:

Staff No:

Signature of the Physical Verifying Authority with remarks Name: Design:

Staff No:

Date:

_______________________________________________________________________________________ NOTE: BUS PASS TYPE & CODE LIST can be obtained from the concerned BUS PASS Centers. Institution codes and Course codes for Twin Cities are available at APSRTC website www.apsrtc.gov.in

INSTRUCTIONS AND EXAMPLES TO FILL IN APPLICATION FORM 1. Application form should be filled properly and legibly with black ink or blue ink ball pen in CAPITAL LETTERS. Fill only one letter in each box leaving one box between words. Student ID Card / Fee Receipt to be enclosed. 2. Please do not overwrite on the Application Form. 3. Only good quality passport size photograph should be pasted on the Application Form attested by the Principal along with Seal. Please DO NOT STAPLE or pin the photograph. 4. Student studying in Evening College shall enclose Unemployment Certificate issued by concerned Head of the Institution. 5. Free bus passes are eligible for below 12 years for boys and girls below 18 years upto 10th class. Free bus passes will be issued only upto 30th September. 6. Student who are 35 years and above age are not eligible for Student Concessional Bus Pass. 7. Student shall ensure the eligibility criteria before applying for the Bus Pass. Once application is rejected due to ineligible conditions, the amount remitted to APSRTC will not be refunded. 8. Student should check for identical preprinted ticket numbers on right top hand and computer generated number at bottom of the ticket before leaving the counter, if not tallied reject the ticket (in City only).