Free Weekend Travel Application Form

This form is for use by: Victorian Seniors Card holders Disability Support Pensioners Carer Payment recipients to access the free weekend travel entitlement, which will be issued on a free myki.

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Visit myki.com.au Call 13 6954 (13 myki)

If you are deaf, or have a hearing or speech impairment, contact us through the National Relay Service: TTY users phone 133 677, then ask for 13 6954 (13 myki). Speak and listen users phone 1300 555 727, then ask for 13 6954 (13 myki). If you need an interpreter: Call the Translating and Interpreting Service (TIS National) on 131 450 and ask for 13 6954 (13 myki).

General Information
All Victorian Seniors Card holders, Disability Support Pensioners and Carer Payment Recipients are eligible for a free myki which contains a free weekend travel entitlement. Your myki will automatically give you free travel on weekends within any two adjacent zones (e.g. Zones 1 and 2) in Victoria when you touch on and touch off. You must carry both your myki and a valid Victorian Seniors Card or Centrelink Pensioner Concession Card with you in order to travel free on weekends. To be eligible for free weekend travel, you must be either: A Victorian Seniors Card holder, or; A Centrelink Disability Support Pensioner, resident in Victoria who is under 60 years of age, or; A Centrelink Carer Payment recipient, resident in Victoria who is under 60 years of age. Seniors Card or Pensioner Concession Card holders from other States and Territories are not eligible for free weekend travel, however they are entitled to travel on concession fares on public transport in Victoria. How to apply for free weekend travel To obtain a free myki containing the free weekend travel entitlement simply complete and post the attached application form to: myki Weekend Travel Applications PO Box 6422 St Kilda Road Central Melbourne, Vic 8008 Privacy The Transport Ticketing Authority (TTA) understands and respects your right to privacy and we are committed to privacy protection. The Information Privacy Act 2000 and TTAs Privacy Policy regulate how we collect and handle your personal information. Visit myki.com.au or call 13 6954 (13 myki) for further information about privacy or our Privacy Policy.

Free Weekend Travel Application Form

How to complete this form
Place a cross X within the appropriate box when selecting an option. Please use BLACK INK and print within the boxes using CAPITAL LETTERS. Unless stated, all elds are mandatory. Please read the Privacy Notice and the Terms and Conditions and sign where indicated.

Title (Mr, Mrs, Miss, Ms, other)

Given name

Family name

Unit number

Street number

PO box number

Street name

Suburb/Town

State

Postcode

Daytime phone number (with area code)

Date of birth

D D
Email address (optional)

M M

Y Y Y Y

Victorian Seniors Card Number

Are you a DSP/CAR pensioner? Yes

If yes, what is your Customer Reference Number (CRN)?

No

SPF-M-002-W

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Privacy Notice
The account holder or cardholder (you) will generally be able to access your personal information. If personal information sought by the Transport Ticketing Authority (TTA) (we or us) is not provided, we may not be able to provide the Card and related services, such as registration. For further information about privacy and on rights of access to personal information, visit myki.com.au or call 13 6954 (13 myki). Personal information provided by or about you or generated by using the Card is collected by Public Transport Authorities# to issue and administer the Card and relevant entitlements. Personal information held by Public Transport Authorities may be used or disclosed (including to each other) for the operation of myki; to verify entitlement to concession travel; for ticketing enforcement; in emergencies; otherwise as required or authorised by or under law; or with your consent. We may send you information about transport-related services. We may contact you about other goods and services which we consider may be of interest, unless you have opted out by crossing the box below or subsequently through the contact details provided.
#

Public Transport Authorities means TTA, the Department of Transport and any agent, contractor or delegate of TTA or the Department of Transport including Metlink and public transport operators.

I DO NOT wish TTA to contact me about other goods and services which it considers may be of interest.

Terms and Conditions

I AGREE TO THE TERMS AND CONDITIONS ON THIS FORM AND HAVE READ THE PRIVACY NOTICE.
Your myki is issued subject to, and its use is governed by, the myki Terms of Use, the Transport (Compliance and Miscellaneous) Act (1983) and Regulations, and the Victorian Fares and Ticketing Manual (myki) (Ticket Conditions), as amended from time to time. The myki Terms of Use limit the Transport Ticketing Authoritys (TTA) liability and may impose certain fees. To obtain a copy or for further information visit myki.com.au or call 13 6954 (13 myki). If your registered myki is lost or stolen, balance protection commences once you have reported it. You can report this at myki.com.au or by calling 13 6954 (13 myki). Replacement of a lost, stolen, damaged or defective myki requires completion of a Replacement myki Form. An administration fee may apply. If your details change, you need to inform TTA. To change your details visit myki.com.au or call 13 6954 (13 myki).

Signature of applicant or legal guardian/agent if applicant unable to sign

please sign

Date

D D

M M

Y Y Y Y

SPF-M-002-W

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