ANDHRA PRADESH STATE ROAD TRANSPORT CORPORATION

STUDENT BUS PASS APPLICATION ABOVE SSC

Previous ID Card No (2015-16)

1. Student 10th Details

1.1

SSC Board Type

APSSC CBSE

1.2

SSC Pass Type

Regular Supplementary

1.4

1.3 SSC Year of pass

2. Student Details
2.1 Name
Father's / Guardians
2.2
Name
Date of Birth
2.3 (dd/mm/yyyy)
As Per SSC
2.5 Aadhar No.
2.7 Is Employee Children
2.8 Email
3. Residential Address Details
3.1 District
3.3 Village
4. Institution Details
4.1 Institution Code
4.3 Mandal
4.5 Course Name
4.7 Admission No
5. Route Details
5.1 Center
5.3 From Place District
5.5 From Place:

ICSE ORIENTAL APOS OTHER BOARD

SSC hall ticket no

Photo

:
:
:
:
:

2.4

Yes NO

Gender

Male
Female

2.6 Mobile No :
If Yes Enter Emp. Id :

:
:

3.2
3.4

Mandal
Address

:
:

:
:
:
:

4.2
4.4
4.6
4.8

District
Institution Name
Present Course Year
Institution Address

:
:
:
:

:
:

5.2
5.4

Pass Type
To Place District

:
:

Via:

To:

Enclosures: Bonafied Certificate, SSC Memo

I hereby declare that the particulars given above are true and found correct. I will abide by the rules & regulations of
APSRTC governing issue of Bus Passes.
Signature of Head of the Institute

Signature of the Student

------------------------------------------------------------------------------------------------------------------------------------------------------------BONAFIDE CERTIFICATE
I hereby certify that Sri/kum/Smt ___________________ is bonafide student of ________________________ (Name of the
Institution) studying _________________ (Name of the course) With Admission No _________& Roll No __________ His /Her
Date of Birth is ______________ (DD-MM-YYYY) as per office records and the course will be completed by _______________
(dd/mm/yyyy).Educational Institute Recognition Code No ________________ (As per the D.E.O. records). Course Code No
_____________ for the Academic year 2016-2017.
Date:
Place:

Principal