Scooter and Wheelchair Travel Pass - Public Transport Victoria

Office use onlyPublic Transport VictoriaFree travel pass application number:Date received from applicant: / /Checked by – initials:Date forwarded to Scooter and Wheelchair TravelPass Panel (SWTPP): / /Date received recommendation from SWTPP: / /Scooter and Wheelchair Travel Pass card number:3 0 8 4 2 5Date applicant advised of recommendation: / /Date Travel Pass issued: / /Scooter and Wheelchair Travel Pass PanelDate received from Public Transport Victoria: / /Date recommendation sentto Public Transport Victoria: / /Recommendation: ApprovedDeclinedComments:Initials: Date: / /PTVH0114Scooter and Wheelchair Travel Pass – Information and application form 27