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Card Replacement Form 25 04 17 PDF

This document is an application form for replacing a myconnect or single-trip public transport card due to faults, damage, or expiration. It requests the applicant's contact details and card information. The applicant must select the reason for replacement - whether the card is faulty, damaged, or expired. Certain replacement costs may apply depending on the reason. The applicant declares the information is true and a guardian must sign if the applicant is under 18. For official use, cashiers validate the application, record replacement details, and note if value was transferred from the original card. The cashier provides a tear-off slip as proof of submission to the applicant.

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Klodian
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518 views1 page

Card Replacement Form 25 04 17 PDF

This document is an application form for replacing a myconnect or single-trip public transport card due to faults, damage, or expiration. It requests the applicant's contact details and card information. The applicant must select the reason for replacement - whether the card is faulty, damaged, or expired. Certain replacement costs may apply depending on the reason. The applicant declares the information is true and a guardian must sign if the applicant is under 18. For official use, cashiers validate the application, record replacement details, and note if value was transferred from the original card. The cashier provides a tear-off slip as proof of submission to the applicant.

Uploaded by

Klodian
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Official use

Application for replacement of card and transfer of value


Please print clearly using block letters Date stamp

1. Passenger details
Title Name Surname

Email ID/Passport number*

Cellphone Landline
*This information will only be used for identification, and will not be shared or used for any other purpose.

2. Card details Please provide details of the myconnect OR single-trip card that you wish to replace

myconnect card number myconnect expiry date

Single-trip card number Single-trip Airport YES NO

3. Application type Please tick the correct option below

Replace faulty card OR Replace expired/expiring card


• Your replacement card will be issued immediately. • Your replacement card will be issued immediately.
• If the issue is due to a system fault, your replacement card will be issued at no • The cost of replacing an expired or expiring myconnect card is as per the tariff.
cost. If the card has been physically damaged, the cost will be as per the tariff. • Value will be transferred immediately, except for money loaded as Standard on
• Value will be transferred immediately. If the card cannot be read, please allow expired cards, which can take up to 32 days.*
up to 10 days for Mover and 32 days for Standard. * Additional terms and conditions may apply.

4. Declaration If the applicant is under 18 years, this form will need to be signed by a guardian
I, the undersigned, understand that providing untrue information constitutes fraud and certify that the information provided is true in all respects.

Signature of applicant or guardian Date

For official use only Date stamp required by cashier

Cashier name Cashier signature

Location/station Date Time

Replacement card no Replacement receipt no

A. Faulty card chip — replacement card [R0.00] E. Expiring card — replacement card [as per tariff]
B. Faulty card aerial — replacement card [R0.00] F. Expired card — replacement card [as per tariff]
C. Damaged card chip — replacement card [as per tariff] G. Faulty single-trip card — replacement card [R0.00]
D. Damaged card aerial — replacement card [as per tariff] H. Damaged single-trip card — replacement card [as per tariff]

Mover Points transfer completed YES NO N/A Standard transfer completed YES NO N/A

Monthly Pass transfer completed YES NO N/A Monthly Pass Airport transfer completed YES NO N/A

Transfer receipt/s attached YES NO N/A Card sales receipts attached YES NO

Infobox loaded YES NO PIN changed YES NO

Customer slip Cashier to complete, tear off and hand slip to passenger

Passenger name Station submitted Date

Cashier name Cashier signature Time

Original card number Replacement card number

Passengers should keep this tear off slip as proof of submission and use surname as reference for enquiries.
Expired cards: 32 days should be allowed for ABSA to transfer Standard.
Passengers will receive communication from the Transport Information Centre on any outstanding transfers.

Call the Transport Information Centre (toll-free 24/7)


0800 65 64 63 www.myciti.org.za MyCiTi Bus @MyCiTiBus

v17/03

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