Ne DELHI TRANSPORT CORPORATION Price of Form Z 1 &S (Govt. of N.C.T. of Delhi) Appli New Pass/Renewals/Refunds (To be filled in Capital Letter only) ation Form for Bus Pass No. 1. Name of the T l Applicant | Name of Father! Husband O = 3. DOB i [] ace | Ph. [ | Residential i. Address [ L | ] eau (Choose only ane from Check List) 5. Category of Pass Holder np s 6. Type of Pass Required Tick [/Jonly one [Destination [All Route Non AC | All Route AC 7. Information Required for Destination Passes Place From, To. 8. Period of Pass Required Date From To For Concessional Passes 9, Student Category eraaaner (0) Name, Address and Code No. ofthe Educational insttute | S°4® NO-| | get tatesteany < NameandAddress Principalitead arenes ofinsttuie (For Students only) (i) Class [—d”di Roll No. (ii) Student Identity Card No. (iv) State whether Employed orNot [i Student's Signature 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 week from the date of issue. eke en eel eee Signature of Principal/Head of Institute {Office Stamp with Address) Documents Name Number 10, Senior Citizens Age Proof Residence Proofi noo 11. Disabled Persons Category (i) NameofHospital issuing Disability Certificate ee Tia (i) Typeof Disability [ORTHOC] OEAF() | BLIND (3)[ MRIMI (ii) Reference No. of SocialWetfare Directorates 42, Free Pass Holders Gategory Name and Address of authority Issuing ‘the verifying Referance Document 43, Refund Required For Weeks / Months, {Signature of the Applicant) (For Office use only) [tis certified that all documents have been checked and foundin order, Signature of Verifying Official Bus pass No. Date of issue | Received & Refunded & Signature of Issuing Clerk tion Payment. of % 151: to be paid towards cost of |D eum Bus Pass, Bus Pass shell be renewed within thee days. Bus Pass charges shall be payable as per DTC notification, ‘The Amount of Pass is refundable in case of complate unused months in category of concessional passes and in.case of General category remaining weeks starting rom the dale ofissue.(subjecttomaximum 3 weeks. Appicaion wil noi be aecapiad withaut Schoal Code (item No. 8) in ease of student. Purchase0ofa Bus Passiteal proves thatpass holders aoceptsallrulas and regulations prevailing forthe rssyaaee of Bus Pass. Bus paseis non-transferable PassHolderhas lo show Bus Pas to any competentofficersicheckingofcialsof the Corporation an demand, falstadoso else has topay the penalty as perrule. 9. Corporation willneitherissue duplicate pass ner refund proportionate farein case of partallcorplete damage, mutation or lass of Bus Pass. 10. The cost of Refunded Ticketis € 10/-perrefund, Cheek List: Tick the documentattached with the form: * Categary of Pass to be mentioned in tam No.5) - Student, BPLIAAY, Freedom Fighter, St. Citzen Infernational Sports Person Disabled, National Awardee. Journalist, War Widows & Dependant, Gen. Public, Student Special ,MLAIMP Residence Proof Ration Card: Vater CarclPass Pot for Senior rizen. For BPUAY certificate (Ration Card) es ed by the Food & Supply Deptt. GNCTD. PIBIDIPINACD Carétor Journalist Press Pass. Disability Certicai from Govt, Hospital, Disablity Certificate fromArea SDM, ‘hge Proof for Sr. Ciizens (Bith Cerificale, School Leaving Certificate, Phato Identiy Card, Ration Card, Pass Port, Retirement Letierfrom Govt. Dent} + Pension Paymentorder & Bank A/c Statement for Freedom Fighters, + National Award Gestficate copy issued by the President of India (Padam Bhushan, adam ibhushan, Padam Shree, Bharat Ratan} + International Sports Certificates rom Govt of tia, + WarWidows Certificates Issued by Appropriate Defence Author