Bus Pass Application - APSRTC
Bus Pass Application - APSRTC
Bus Pass Application - APSRTC
You also want an ePaper? Increase the reach of your titles
YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.
APPLICATION FOR<br />
STUDENT BUS PASS<br />
FREE SUPPLY<br />
( RTC-282/R )<br />
ANDHRA PRADESH STATE ROAD TRANSPORT CORPORATION<br />
1. NAME OF THE STUDENT (Maximum 20 Characters):<br />
Name<br />
Surname<br />
PHOTO<br />
2. Father’s/Mother’s Name: (Maximum 20 Characters):<br />
Name<br />
Surname<br />
D D M M Y Y Y Y<br />
3. Date of Birth: 4. Sex :<br />
5. Type of <strong>Pass</strong> : 6. <strong>Bus</strong> <strong>Pass</strong> Code :<br />
7. Institution Code: Institution Name:<br />
8. Course Code : Course Name:<br />
9. Admission No. :<br />
10. Route Particulars: From To<br />
Via<br />
11. Residential Address :<br />
H.No.<br />
Street<br />
Village<br />
Mandal<br />
District<br />
Pin Code<br />
Cell No.<br />
M<br />
F<br />
I hereby declare that the particulars given above are true and correct. I will abide by the rules<br />
& regulations of <strong>APSRTC</strong> governing issue of <strong>Bus</strong> <strong>Pass</strong>es.<br />
BONAFIDE CERTIFICATE<br />
Signature of the Candidate.<br />
I hereby certify that Sri / Kum / Smt. …………..……………………………….…………………… is a bonafide<br />
student of ……………………………………………………… (Name of the institution) studying ……….………….. (Name<br />
of the course) with Admission No ……….………….…….. & Roll No ……….……………. His / Her Date of Birth is<br />
………...…………….. (DD/MM/YY) as per office records and the course will be completed by<br />
……………………………. (DD/MM/YY). Educational Institute Recognition Code No ………………………. (As per<br />
the D.E.O. records). Course Code No …..….………… for the Academic year …..…………..……<br />
Date:<br />
Place:<br />
Signature of Head of the Institution with Seal.
Page - 2<br />
For Office Use Only<br />
DD<br />
MM YY<br />
M.R. No./Ack.Receipt No:<br />
Receipt Date:<br />
<strong>Bus</strong> <strong>Pass</strong> ID No.<br />
<strong>Bus</strong> <strong>Pass</strong> Ticket No:<br />
<strong>Pass</strong> Amount Rs.:<br />
Route Code :<br />
<strong>Pass</strong> Issued at :<br />
Route Kms.:<br />
Signature of the Issuing Authority. Signature of the Physical Verifying Authority with remarks<br />
Name:<br />
Name:<br />
Design: Staff No: Design: Staff No:<br />
Date:<br />
Date:<br />
_______________________________________________________________________________________<br />
NOTE: BUS PASS TYPE & CODE LIST can be obtained from the concerned BUS PASS Centers.<br />
Institution codes and Course codes for Twin Cities are available at <strong>APSRTC</strong> website www.apsrtc.gov.in<br />
INSTRUCTIONS AND EXAMPLES TO FILL IN APPLICATION FORM<br />
1. <strong>Application</strong> form should be filled properly and legibly with black ink or blue ink ball pen in<br />
CAPITAL LETTERS. Fill only one letter in each box leaving one box between words. Student<br />
ID Card / Fee Receipt to be enclosed.<br />
2. Please do not overwrite on the <strong>Application</strong> Form.<br />
3. Only good quality passport size photograph should be pasted on the <strong>Application</strong> Form<br />
attested by the Principal along with Seal. Please DO NOT STAPLE or pin the photograph.<br />
4. Student studying in Evening College shall enclose Unemployment Certificate issued by<br />
concerned Head of the Institution.<br />
5. Free bus passes are eligible for below 12 years for boys and girls below 18 years upto 10 th<br />
class. Free bus passes will be issued only upto 30 th September.<br />
6. Student who are 35 years and above age are not eligible for Student Concessional <strong>Bus</strong> <strong>Pass</strong>.<br />
7. Student shall ensure the eligibility criteria before applying for the <strong>Bus</strong> <strong>Pass</strong>. Once application<br />
is rejected due to ineligible conditions, the amount remitted to <strong>APSRTC</strong> will not be refunded.<br />
8. Student should check for identical preprinted ticket numbers on right top hand and<br />
computer generated number at bottom of the ticket before leaving the counter, if not tallied<br />
reject the ticket (in City only).