GURU NANAK INSTITUTIONS

Ibrahimpatnam, R.R. District-501506, Ph: (0/95) 8414-202120/21/23, Fax: 08414-223344

BUS PASS APPLICATION FORM

NAME OF THE COLLEGE: ________________________________________________

Paste
1. Name of the Student:
your recent
Passport size
photograph
2. Father’s/ Guardian’s Name:

3. Date of Birth (DD / MM / YYYY): D D M M Y Y Y Y

4. Roll No.: Year / Branch ______________________

5. Gender (Male / Female) :___________________ Blood Group (Mandatory) _________________

6. Pick up Point (Specific) :_______________ Route No.:_______(To be confirmed by Transport Section)

7. Address.:___________________________________________________________________________

_________________________________________________________________ Pin:

8. Contact No. (Mobile): Landline:

9. Aadhaar Card No. :

10. Contact Person in an Emergency:

Name : Relationship:_________________

Contact No.:

OFFICE USE - ACCOUNT SECTION

Period from____________________ to__________________

Bus fee paid Rs.__________________ Receipt No.__________________ Date:_________________

Signature of the Accountant

OFFICE USE – TRANSPORT SECTION

Sute Sl. No.:_________________ Register Sl. No.:_________________ Bus Route Allotted :_______________.

Administrative Officer
I hereby certify and undertake to adhere AND abide by the following conditions:

a) I will not indulge in RAGGING directly or indirectly in the bus. If reported, I understand that I
would forfeit my bus pass and will neither be allowed to travel in the bus not entitled to any
refund.
b) I will reach my allocated stop 5 minutes before the scheduled arrival of the bus and wait. I
shall obey the instructions of bus in charge or the bus driver.
c) I will not demand a seat in the event of migrating to another route subsequently.
d) During breakdown of any other bus I will cooperate, adjust and accommodate displaced
occupants of the broken down bus.
e) During the University Examination I understand that I will not be dropped exactly at my
pickup point but as far as possible near my pickup point. I have no objection to this.
f) I understand that the facility of providing bus by the college is as welfare measure and not
my right.
g) I am fully aware that (am travelling at my own risk and will not seek any compensation.
h) I shall always carry the bus pass issued to me and produce it as and when demanded by the
College administration. Otherwise penalty of Rupees five hundred will be imposed on me.
i) I will not damage the bus in anyway. If found guilty my bus pass may be terminated and I
may be penalized.
j) I agree to observe all the rules and regulations of the College.
k) I will travel only in the bus allotted to me. If found traveling in another bus, I shall forfeit my
bus pass and pay a penalty as levied by the management.
l) I shall board from allocated pick up point.
m) I shall not misbehave with the students / driver / staff while traveling. In case of any
inconvenience I shall contact the transport manager.

Signature of the Parent Signature of the Student