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Delhi Transport Corporation (Govt. of NCT of Delhi) : Application Form For Concessional Pass

(1) This document is an application form for a concessional bus pass from the Delhi Transport Corporation. (2) It requests information such as name, age, address, category of pass holder, type of pass, and period required. (3) Additional information is required depending on the applicant category, such as educational institute details for students, disability details for disabled applicants, and verifying documents for free pass holders.

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DhananjayKumar
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© © All Rights Reserved
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Download as PDF, TXT or read online on Scribd
334 views

Delhi Transport Corporation (Govt. of NCT of Delhi) : Application Form For Concessional Pass

(1) This document is an application form for a concessional bus pass from the Delhi Transport Corporation. (2) It requests information such as name, age, address, category of pass holder, type of pass, and period required. (3) Additional information is required depending on the applicant category, such as educational institute details for students, disability details for disabled applicants, and verifying documents for free pass holders.

Uploaded by

DhananjayKumar
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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DELHI TRANSPORT CORPORATION

(Govt. of NCT of Delhi)


Application form for Concessional Pass
New Pass/Renewal/Refund
(To be filled in Capital Letter Only)
1 Name of the applicant __________________________________________________
2 Name of Father/Husband __________________________________________________
3 Age __________________________________________________
4 Residential Address __________________________________________________
__________________________________________________
5 Category of Pass Holder Tick () only one
Stu- Residents of Freedom Senior Internat- Dis- National Journa- War widow Police
dents Resettle- Fighters Citizens ional abled Award lists & their
ment Sportsman Winners dependant
colonies Children

01 02 03 04 05 06 07 08 09 10

6 Type of Pass required


Destination All Route All Route GLS
(Tick () only one)

Information required for destination passes


(a) Pass required: From (Place)_______________To (Place)______________Change (Place)____
2A 2B
(b) Distance
(Tick () only one) 10 Kms 10 Kms
(To be filled by residents of resettlement colonies)

(c) Route Numbers to be allowed:


Source to Change-over___________________________________
Change-over to destination_____________________________

7 Period of Pass required From_________________ To __________________


(dd/mm/yy)
Tick () only one 01 02 03 04 05 Months

8 Students
(i) Name and address of the Educational Institute-----------------------------------------------------------
--------------------------------------------------------------
Code No:
Paste recent
Photograph & Get it
(To be filled by school/college authorities) attested by the
Principal/Head of
(ii) Class: Roll No. : Institution (if school
ID is not available)
(iii) Student Bus Pass Validity Card No.-----------------------------------------------------------------------
(If not available paste a photograph on the application
and get it attested by the principal/Head of the Institution).
(iv) If Employed Mention Name, Address & Tel. No. of the Employer.
___________________________________________________________________________
__________________________________________________________________________
City: ________________ Pin: _______________ Tel.No.: ________________________

9 Disabled
(i) Name of the Hospital
Issuing disability certificate ----------------------------------------------------------------------------
(ii) Type of degree of ORTHO(1) DEAF (2) BLIND (3)
Disability (Tick () only one)
(iii) Reference No. of Social
Welfare Directorate ----------------------------------------------------------------------------
(iv) Place of work ----------------------------------------------------------------------------

10 Free Pass Holders


(i) Name and Address of authority
issuing the verifying reference document.
(ii) Certificate No.

11 Refund required From __________________


DD/MM/YY

(Signature of the Applicant)


(For Students only)
It is certified that the columns filled by the student are correct and have been verified from our
records and it will be valid for 5 months. The certificate is valid for two weeks from the date of issue.

Signature of Principal/Head of Institution


Date: _____________ (Office Stamp with address)
(For Office use only)
Bus Pass validity card
Number Allotted: Date of Issue:

Received Rs.:

Refunded Rs.:

Signature of Verifying Official Signature of Cashier

1 Payment of Rs 10/- to be paid for preparation of each Photo bus Pass Validity Card.
2 A service charge of Rs.2/- by students and Rs.7/- by other than free pass holder to be paid for
each bus pass.
3. Bus Pass shall be renewed within last five days (if the last day of the renewal is holiday/Sunday
renewal it before 4 days. Failure to do so, a reactivation charge of Rs. 10/- extra will be levied)
4 Bus pass charges shall be payable as per D.T.C. notification.
5 All charges paid are non-refundable except for bus pass charges for period of more than 1
week.
6 A refund charge of Rs.10/- shall be charged extra for each refund.
7. Any Miscellaneous Service by Computer. Rs. 10/- will be Charged.
8. Application will not be accepted without School Code (Item No. 8) in case of Student.
9. Bus pass is issued under standard terms and conditions of D.T.C.

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