Application for Issue of Bus Pass

Bus Pass for AC Non AC

Photo paste
here
1. Name : _________________________________________
2. Father’s Name : __________________________________
3. Gender : MALE FEMALE
4. Address : _______________________________________
5. Phone/Mobile No. :________________________________
6. Fare to be paid (Including Rs. 30/- Facilitation fee)_______

Category :-Student Govt. Employee

General Category Senior Citizen

1. Student/Employee / Applicant Name _________________________________

2. Name & Address of Office/ Institution (recog.)/ Applicant _________________
________________________________________________________________
3. Applicant whether Private or Govt. Employee or Student_________________

4. Mention route no. here for specific bus passes_________________________

Signature of Applicant Authorised Signatory

Mobile /Telephone No. with Stamp of Organization
___________________
Name :
Designation:
Phone No.

INSTRUCTIONS:-

The Photo and Form both will be attested by the HOD Authorised Signatory
of Department/ Institution as the case may be. Also enclose one extra
photograph.

Senior Citizen may submit this form along with Photo ID proof and proof of
his /her age.

The name, contact address with proof, Phone No. & signature of authorised
signatory of recognised educational institution/govt. office should be
submitted to the Traffic Branch, of CTU i.e. Plot No. 701, Industrial Area,
Phase-1, Chandigarh, Ph. No. 0172-2679003.

Duly filled form to be submitted at any e-Sampark Centre to get the bus
pass issued.

In case of general passes , the applicant shall submit his/her identification

proof along with photo.