Ateneo Gate Pass Sticker

Application Form SY __________

Check applicable category Ateneo ID No: _______________

Name __________________________________________
New Sticker No:
______ Student
______ Faculty Unit: GS Primary School Grade & Section _____________
_____________
______ Administrator GS Middle School Grade & Section _____________
______ Professional/Staff HS Year & Section _____________
RMI No:
______ Auxiliary/Affiliate LS Year & Course _____________
______ Business /Tricycle Other ________________________________________
_____________
______ Alumni/Visitor
(Visito
checkSticker
Current box if applicant/owner has NEVER been issued a sticker previously
No:______________
Owner’s Name: _________________________________________________________________________________
(first name) (middle name) (last name)
E-mail: _______________________________ Tel no.: _____________ Mobile phone:________________________

Home Address: _________________________________________________________________________________

Driver’s Name: _________________________________________ Driver’s License No. _______________________

LTO Car Registration No.: ________________________________ Date: ___________________________________

LTO Official Receipt No. : _________________________________ Date: ___________________________________

Make: _______________ Model: ___________ Year: _________ Color: _________ Plate No: ________________

Please read the Applicant’s Pledge below and the Campus Traffic and Parking Violations at the back and sign as
indicated. Thank you.

APPLICANT’S PLEDGE

If my application is approved, I pledge to:

1. Ensure that my vehicle meets the exhaust emission standard as certified by a government accredited exhaust
emission test center and to comply with periodic exhaust and road side emission tests as may be required on
campus during the school year.
2. Ensure that a driver with a valid driver’s license operates my vehicle.
3. Instruct the driver to strictly observe Ateneo traffic/parking rules and regulations.
4. Instruct the driver not to drink intoxicating liquor or gamble or engage in inappropriate behavior while inside the
campus. Penalty P2000
5. Attach the gate pass sticker on the driver’s side of the front windshield of my vehicle with the full
knowledge that the gate pass sticker is non-transferable and specifically for the vehicle described above.
6. Promptly pay the P1000 penalty if the gate pass sticker is not attached to the windshield.
7. Pay the P3000 penalty if the gate pass sticker is used on another vehicle other than the one described
above.
8. Promptly pay the fine for traffic and parking violations I or my authorized driver may commit;
9. Notify the University Physical Plant Office of a) change of license plate number, b) change of vehicle ownership,
and c) vehicle repair or alteration.
10. Face possible administrative or disciplinary sanctions in the unit concerned in the event of multiple offenses
committed within the fiscal year.

I also acknowledge receipt of a copy of the Ateneo Traffic/Parking Rules and Regulations with the schedule of
violation penalties.

Signature of owner of vehicle: ________________________

Printed Name: ________________________

March 2012 Date: ________________________

 ATENEO DE MANILA UNIVERSITY
Loyola Heights, Quezon City

CAMPUS TRAFFIC & PARKING VIOLATIONS

March 26, 2012
TRAFFIC: PENALTY

1. Driving on campus without valid driver’s license. P2,000

2. Obstructing Traffic: Driving against the traffic or blocking traffic. P1,000
3. Failure to give way to pedestrians on pedestrian lane. P1,000
4. Reckless Driving: Violation of speed limit, disregarding traffic signs. P3,000

5. Smoke Belching. P 500

6. Jaywalking. P 500
7. Driving vehicle on sidewalk & pedestrian walkway P1,000
8. Loading or unloading at NO loading /unloading zones. P1,000

PARKING:

1. Unauthorized parking/overnight parking on campus. P3,000

2. Leaving vehicles unlocked while parked. P1,000
3. Running the engine while parked. P2,000
4. Parking in NO Parking zone. P1,000
5. Parking on sidewalk and driveway. P1,000
6. Parking in reserved areas. P1,000
7. Improperly parked vehicle (vehicle occupying two parking slots). P1,000

GATE PASS STICKER / PROXIMITY CARD:

1. Fake/altered gate pass sticker/proximity card. P5,000

2. Gate Pass Sticker/proximity card was used not for the vehicle for which it
was issued. P3,000
3. Gate Pass Sticker not attached on the windshield. P1,000
4. Cars with sticker but no proximity card will be asked to park at Northwest P 500
Parking.

OTHERS:

1. Discourtesy/verbal abuse towards other drivers, students, pedestrians, or

traffic enforcer. P2,000
2. Vandalism, removal or defacement of street signs. P1,000

The University’s traffic and parking rules are designed to create a safe environment for
pedestrians, bicyclists and motorists, and to provide for the community’s daily transit needs.
Please cooperate and help protect life and property.

I agree to follow the Ateneo campus traffic and parking rules listed above and other policies that
may be issued by the university from time to time and pay the corresponding fee when I violate
any of the above rules.
____________________________________
Signature over printed name of vehicle owner
___________________